Evaluation of influencing factors on tubal sterilization regret: a cross-sectional study

Background: The aim of this study is to evaluate the menstrual pattern, sexual function, and anxiety, and depression in women with poststerilization regret, and potential influencing factors for regret following tubal ligation [TL] in Iranian women

Materials and Methods: In this cross-sectional study, 166 women with TL were subdivided into two groups including women with poststerilization regret [n=41] and women without poststerilization regret [n=125]. They were selected from a health care center in Guilan province [Iran] during 2015-2016. Menstrual blood loss was measured using the Pictorial Blood Loss Assessment Chart [PBLAC] and through a self-administered questionnaire. In addition, sexual function was assessed by the Female Sexual Function Index [FSFI], and psychological distress was measured by employing the Hospital Anxiety and Depression Scale [HADS]. Student's t test and Chi-square test were used to reveal the statistical differences between the two groups. We used logistic regression to determine the influencing factors associated with regretting sterilization

Results: Women with poststerilization regret had more menorrhagia [78 vs. 57.6%, P=0.03] than those who did not regret sterilization. A significant difference was found in sexual dysfunction in orgasm [P=0.02], satisfaction [P=0.004], pain [P=0.02], and total FSFI scores [P=0.007] between the two groups. Also, there was a significant difference between the two groups in anxiety, depression and total scores HADS [P=0.01]. In the logistic regression model, age of sterilization [odds ratio [OR=2.67], confidence interval [CI]: 1.03-7.81, P=0.04]], pre-sterilization counseling [OR=19.92, CI: 6.61-59.99, P<0.001], score of PBLAC [OR=1.01, CI: 1.004-1.01, P=0.001], the number of days of bleeding [OR=1.37, CI: 1.01-1.99, P=0.04], and the length of menstrual cycles [OR=0.91, CI: 0.84-0.99, P=0.03] were significantly associated with regretting sterilization

Conclusion: Complications due to sterilization are the main causes of regret; therefore, it is necessary to pay due attention to mentioning the probable complications of the procedures such as menstruation disorders, sexual dysfunction, and anxiety and depression in women during pre-sterilization counseling

Development and psychometric properties of the decision making on the type of delivery questionnaire in Iranian women

Background: A tool which can help to decide on the determinants in selecting the delivery type is an effective step towards the goals of the World Health. This study aimed to develop and evaluate the psychometric properties of a scale based on Iranian culture to make decision on the type of delivery

Methods: This is a methodological study using a questionnaire proposed by Schneider. The following steps were used to design the project. In the first step, perceptions and experiences of 45 pregnant women, postpartum women, midwives, gynecologists and non-pregnant women were determined based on interviews and observations using focused ethnography. In the second stage, the terms in the questionnaire based on qualitative study was assessed. Then, in the third stage, psychometric testing of the decision making on the type of delivery scale [DMTDS] based on the cultural concepts of decision making towards the type of delivery and its influencing factors based on focused ethnography using face validity, content validity, construct validity, internal consistency and reliability was done on400 pregnant and postpartum women

Results: The initially developed scale consisted of 60 items on a 5-point Likert scale, which reduced to 43 items following measurement of the face and content validity. The results of the exploratory factor analysis elicited 36 items and a seven-factor structure including motivational beliefs on vaginal delivery, social beliefs towards childbirth, motivational beliefs on cesarean delivery, personal beliefs, sources of information, catastrophic thinking and child birth experiences. Cronbach's alpha coefficient [0.80] confirmed the high internal consistency of the scale

Conclusion: The developed questionnaire appears to be a valid and reliable tool for health care providers to measure the women's decision making towards type of delivery. Therefore, this tool can be used in the Iranian community. The scale may help the midwives and obstetricians to be aware of the women's decision regarding their choice of delivery and as a result to plan appropriately in order to reduce unnecessary cesarean sections

Using growth mixture modeling for clustering Asian and north African countries on the road injury death trend [1990-2010]

Objectives: The physical injuries and financial implications as a result of road accidents have serious economic, cultural, and social effects. We conducted this study to determine any changes in the trend of road-accident-related deaths in Asian and North African countries from 1990 to 2010

Methods: The current study was carried out using data from the Global Burden of Disease database. First, the process was assessed using the growth curve divided into six regions. Moreover, the classification was done based on the death rate using growth mixed modeling

Results: The road injury death trend for men had more variations than women. Classification of these countries based on mortality using the latent growth mixture model resulted in more homogeneous classes according to trend in road fatalities. Disregarding gender and sex, there were four optimal classes. The first three classes had a decreasing trend with the third class having the greatest decreasing trend. South Korea and Taiwan were in this group. Afghanistan, Indonesia, Thailand, Iran, the UAE, Saudi Arabia, and Oman lay in group 4 and had an increasing trend in road injury deaths

Conclusions: Successful interventions that developed countries have used to avoid casualties of road injuries could be used in developing countries. These include passing laws making the use of seatbelts and child seats compulsory and determining appropriate speed limits

Effectiveness of Multidisciplinary Group-Based Intervention versus Individual Physiotherapy for Improving Chronic Low Back Pain in Nursing Staff: A Clinical Trial with 3- and 6-Month Follow-Up Visits from Tehran, Iran

STUDY DESIGN: Clinical trial. PURPOSE: To evaluate the effectiveness of a multidisciplinary group-based intervention on improving pain and disability among Iranian nurses with chronic low back pain in Tehran, Iran. OVERVIEW OF LITERATURE: Although low back pain (LBP) is one of the most important health problems, the challenge remains on how to find an effective intervention to reduce pain and related disabilities. METHODS: Overall, 136 eligible nurses with chronic mechanical LBP were classified into two groups. The intervention group (n=66 participants) participated in a physiotherapy educational program (for 120 minutes) plus a health educational program based on predictive constructs of the social cognitive theory (for 120 minutes). These interventions were delivered by a physiotherapist and a health education specialist. The control group (n=70 participants) participated in a physiotherapy educational program (for 120 minutes). Disability rate, pain severity, and back pain prevention behavior were measured initially and at 3- and 6-month follow-up visits using the visual analogue scale, Roland-Morris Disability, and Nursing Low Back Pain Preventive Behaviors Questionnaire. Data were analyzed by SPSS ver. 16. RESULTS: There were statistically significant differences between the two groups in the main outcome measures immediately after the educational program and at 3- and 6-month follow-up visits. Preventive behaviors of participants in the intervention group were improved at 3- and 6- month follow-up visits (p<0.001). The mean scores of predictive constructs regarding LBP preventive behaviors in the intervention group were improved after 3 and 6 months (p<0.001). Finally, in the intervention group, pain severity and disability were decreased significantly. CONCLUSIONS: This study showed that a multidisciplinary educational program intervention can be an effective approach for reducing LBP and related disabilities among nurses.

Menstrual pattern following tubal ligation: a historical cohort study

Background: Tubal ligation [TL] is recommended for women who have completed their family planning. The existence of the menstrual disorders following this procedure has been the subject of debate for decades. This study was conducted to identify the relationship between tubal ligation and menstrual disorders

Materials and Methods: A historical cohort study was carried out on 140 women undergoing tubal ligation [TL group] and on 140 women using condom as the main contraceptive method [Non-TL group]. They aged between 20 and 40 years and were selected from a health care center in Rudsar, Guilan Province, Iran, during 2013-2014. The two groups were comparable in demographic characteristics, obstetrical features and menstrual bleeding pattern using a routine questionnaire. A validated pictorial blood loss assessment chart [PBLAC] was also used to measure the menstrual blood loss

Results: Women with TL had more menstrual irregularity than those without TL [24.3 vs. 10%, P=0.002]. Women with TL had more polymenorrhea [9.3 vs. 1.4%, P=0.006], hypermenorrhea [12.1 vs. 2.1%, P=0.002], menorrhagia [62.9 vs. 22.1%, P<0.0001] and menometrorrhagia [15.7 vs. 3.6%, P=0.001] than those without TL. There is a significant difference in the PBLAC score between women with and without TL [P<0.0001]. According to logistic regression, age odds ratio [[OR=1.08, confidence interval [CI]:1.07-1.17, P=0.03]], TL [OR=5.95, CI: 3.45-10.26, P<0.0001] and cesarean section [OR=2.72, CI:1.49-4.97, P=0.001] were significantly associated with menorrhagia

Conclusion: We found significant differences in menstrual disorders between women with and without TL. Therefore, women should be informed by the health providers regarding the advantages and disadvantages of TL before the procedures

Work-Related Low Back Pain Treatment: A Randomized Controlled Trial from Tehran, Iran, Comparing Multidisciplinary Educational Program versus Physiotherapy Education

STUDY DESIGN: Clinical trial. PURPOSE: To compare the multidisciplinary educational program versus physiotherapy education among Iranian nurses. OVERVIEW OF LITERATURE: Low back pain (LBP) can accompany significant occupational injuries in the nursing profession. There is no agreement on the most effective educational practice. METHODS: This study was conducted from August 17, 2014 to September 22, 2014 in Tehran, Iran. Eligible nurses with chronic mechanical LBP (n=136) were classified into an intervention group (n=66) or the control group (n=70). The intervention group received physiotherapy education for 120-minutes followed by a 120-minute health education session based on predictive constructs of social cognitive theory (SCT). The control group received the 120-minute physiotherapy education. Disability rate, pain severity and back pain prevention behavior were measured at initially and 3 months after intervention using visual analogue scale, Roland-Morris disability questionnaire and nursing low back pain preventive behaviors questionnaire. RESULTS: The two groups were the same in terms of all studied variables at the initiation of the study. At the 3-month follow up, predictive constructs of LBP preventive behaviors of participants in the intervention were improved (p<0.001). Significant decreases were evident at 3 months in pain severity (p=0.03) and disability (p=0.003). CONCLUSIONS: The designed multidisciplinary educational intervention could decrease chronic mechanical LBP in nurses.

Development and Psychometric Evaluation of Nursing Low Back Pain Predictor Questionnaire Focusing on Nurses Suffering from Chronic Low Back Pain in Iran

STUDY DESIGN: Development and psychometric evaluation. PURPOSE: Design and psychometric assessment of the Nursing Low Back Pain Predictor Questionnaire addressing nurses suffering from chronic low back pain in Iran. OVERVIEW OF LITERATURE: Low back pain is the most prevalent behavior-related health problem among nurses, and it needs to be assessed through a validated multi-factorial questionnaire, using the premises of the social cognitive theory. METHODS: This was a cross-sectional study carried out in Tehran, Iran from April 17, 2014 to July 16, 2014. A 50-item questionnaire based on the social cognitive theory was generated. The questionnaire was distributed among 500 nurses working in hospitals located in different geographically areas in Tehran. Exploratory factor analysis was used to determine the factors and their related items. Cronbach's alpha was calculated to assess reliability. RESULTS: The exploratory factor analysis loaded six factors, named observational learning, outcome expectations, self-efficacy, self-regulation, and self-efficacy in overcoming impediments in the working environment and emotional coping. All factors were jointly accounted for 67.12% of behavior change variance. The Cronbach's alpha coefficient showed excellent internal consistency (alpha=0.91). Test and retest analysis with 2-week intervals indicated an appropriate stability for the questionnaire (intraclass correlation coefficient=0.94). CONCLUSIONS: According the results, the developed questionnaire is a reliable and validated theory-based instrument, which can be used to predict the work, related factors for low back pain among nurses.

Health-related quality of life in polycystic ovary syndrome patients: a systematic review

Increasing attention to the concept of polycystic ovary syndrome [PCOS] health-related quality of life has led to the development of tool that aims to measure this concept. The purpose of this study was to conduct a systematic review of psychometric properties of the PCOS health-related quality of life questionnaire. A search of database [Pubmed, PsychInfo, CINAHL, CENTRAL, Scopus and SID] from January1998 to December 2013 yielded 6152 references of which 27 papers remained after review of the titles and abstracts. The reviewers used structural tools to analyze the articles, critically appraise papers, and extract the data. Finally, eight papers met the full inclusion criteria. A search of database [Pubmed, PsychInfo, CINAHL, CENTRAL, Scopus and SID] from January1998 to December 2013 yielded 6152 references of which 27 papers remained after review of the titles and abstracts. The reviewers used structural tools to analyze the articles, critically appraise papers, and extract the data. Finally, eight papers met the full inclusion criteria. The PCOSQ/MPCOSQ showed acceptable content and construct validity, reliability and internal consistency. However, some other properties, particularly those related to factor and longitudinal validity, absolute error of measurement, minimal clinically important difference and responsiveness still need to be evaluated

Challenges of applying continuing education in Tehran hospital practice as viewed by nurses

Although many planners of professional continuing education programs believe that this type of education positively affects the nurses' performance, the results obtained by conducted research do not confirm such a perspective. In fact, inadequate application of these trainings in clinical practice is among the most challenging areas in nursing practices. Hence, this study was conducted to describe the challenges nurses encounter in order to apply what they have learned during continuing education programs in clinical settings of TUMS hospitals. This cross-sectional study was conducted on 400 medical-surgical nurses who worked in the hospitals of Tehran University of Medical sciences. For sampling, after listing all the general hospitals, their wards were selected in proportion to hospital. Nurses filled out a questionnaire about factors affecting the application of continuing education. The questionnaire contained 43 items and the dimensions were supportive-organizational, individual, professional, and educational program design factors. The analysis was carried out using parametric and non-parametric method using SPSS 16 package. The results showed while 48.5% and 53.8% of nurses mentioned organizational and professional factors, respectively as the most inhibiting factors; only 2.25% of the nurses believed that organizational factors are facilitating. The results obtained in this study are important regarding the fact that organizational and professional factors have a key role in applying or lack of application of learned materials. Thus, hospital authorities as well as nursing managers can provide the necessary condition in application of continuing education through promotion of facilitating factors and eliminating the hindering ones

molecular survey of campylobacter jejuni and campylobacter coli virulence and diversity

The aim of this study was to determine the prevalence of virulence-associated genes and enterobacterial repetitive intergenic consensus PCR [ERIC-PCR] analysis of Campylobacter spp. isolated from children with diarrhea in Iran. A total of 200 stool specimens were obtained from children under 5 years during July 2012 to July 2013. Detection of C. jejuni and C. coli was performed by standard biochemical and molecular methods. The presence of virulence-associated genes and genetic diversity of isolates was examined using PCR and ERIC-PCR analyses. A total of 12 [6%] Campylobacter spp. were isolated from patients including 10 [4.5%] C. jejuni and 2 [1.5%] C.coli. The flaA, cadF and ciaB genes were present in 100% of isolates, while no plasmid of virB11 gene was present in their genome. The prevalence of invasion-associated marker was 100% among C. coli and was not detected in C. jejuni isolates. The distribution of both pldA and the genes associated with cytolethal distending toxin [CDT] was 58.3% in C. jejuni isolates. Seven distinct ERIC-PCR profiles were distinguished in three clusters using ERIC-PCR analysis. Genotyping analysis showed a relative correlation with geographic location of patients and virulence gene content of isolates. To our knowledge, this is the first molecular survey of Campylobacter spp. in Iran concerning genotyping and virulence gene content of both C. jejuni and C. coli. ERIC-PCR revealed appropriate discriminatory power for clustering C. jejuni isolates with identical virulence gene content. However, more studies are needed to clearly understand the pathogenesis properties of specific genotypes

Sexual functioning among married Iranian women with polycystic ovary syndrome

This study aimed to assess sexual functioning among women with polycystic ovary syndrome [PCOS] in Iran. A cross-sectional study was conducted to ascertain factors related to sexual functioning in 300 PCOS patients attending to the private practice centers in Kashan, Isfahan Province, Iran, from May to October 2012. The Female Sexual Function Index [FSFI] was used to measure sexual functioning. Moreover, the socio-demographic details and clinical information of PCOS including obesity, hirsutism, acne, menstrual cycle disturbances, infertility and endocrine profile were recorded for each patient. Overall the prevalence of female sexual dysfunction [FSD] was 16.6%. In particular patients indicated poorer sexual functioning for the desire [48.3%] and the arousal [44.7%] subscales. Multiple logistic regression analysis suggested patients with lower educational level [OR: 2.94; 95% CI: 1.46-5.92] and irregular menstrual status [OR: 4.61; 95% CI: 1.93-11] were more likely to report sexual dysfunction. The findings suggest that desire and arousal were the most prevalent sexual disorders reported in this patient population. In addition, findings suggested that women with limited or no formal education and a history of menstrual irregularities were the most likely to report female sexual dysfunction. Further investigations are needed to examine female sexual functioning among women with PCOS, to educate their health care providers, and to develop therapeutic interventions

Determination of affected risk factors on time to recurrence and death in patients with postoperative gastric cancer using copula function

In survival studies when the event times are dependent, performing of the analy-sis by using of methods based on independent assumption, leads to biased. In this paper, using copula function and considering the dependence structure between the event times, a paramet-ric joint distribution has made fitting to the events, and the effective factors on each of these events would be determined. This retrospective cohort study was conducted from March 2003 to March 2007. The data collected from 256 patients with gastric cancer who underwent surgery and that the event time of the two outcomes of death and recurrence for them was recorded. Akaike Information Criterion [AIC] was used to determine of suitable parametric models. Moreover, applying copula function with regard to the relationships between the events, the effect of the risk factors of each of the two outcomes was determined. The data analysis was done using R2.12.1 software. According to the AIC criterion, the Weibull distribution had the best fitting in both of the event times. The median times for recurrence and survival of the patients were estimated 20.2 and 28.1 months respectively. Furthermore, with a fitting of Weibull distribution to the two event times using Clayton copula function, the variables of gender, tumor size and tumor pathological stage on survival, and tumor size and tumor pathological stage on recurrence were significant [P<0.001]. Applying copula function for determining specific risk factors of the semi-competing events produces suitable results opposite the common methods which are based on independent assumption of the events.

Household health costs: direct, indirect and intangible

Background: This study aimed at identifying components of the household health costs

Methods: This study was a qualitative research conducted in two main phases. The first phase consisted of interviews with sample households selected in eight provinces of Iran. They were to identify components of the household health costs. In the second phase, components were determined as direct, indirect and intangible based on a content analysis

Results: In the first phase of the study, 93 components of households' health costs were identified. According to the content analysis, 44 components were categorized as direct costs, 10 components were indirect and 39 components were categorized as intangible

Conclusion: All components of households' health costs including: direct, indirect and intangible costs, should be considered in the planning and policy-making in the health system

Application of semi-parametric single-index two-part regression and parametric two-part regression in estimation of the cost of functional gastrointestinal disorders

For the purpose of cost modeling, the semi-parametric single-index two-part model was utilized in the paper. Furthermore, as functional gastrointestinal diseases which are well-known as common causes of illness among the society people in terms of both the number of patients and prevalence in a specific time interval, this research estimated the average cost of functional gastrointestinal diseases. Health care policy-makers seek for real and accurate estimations of society's future medical costs. However, data dealt with in hygienic studies have characteristics which make their analysis complicated; distribution of cost data is highly skewed since many patients pay great costs. In addition, medical costs of many persons are zero in a specific time interval. Indeed, medical costs data are often right skewed, including remarkable number of zeros, and may be distributed non-homogeneously. In modeling these costs by the semi-parametric single-index two-part model, parameters were determined by method of least squares; a result of this method was compared with the results yielded from two-part parametric model. Average costs of functional gastrointestinal diseases and their standard deviation in semi-parametric and parametric methods were yielded as $72.69 +/- 108.96 [R[2]=0.38] and $75.93 +/- 122.29 [R[2]=0.33] respectively. Based on R[2] index, the semi-parametric model is recognized as the best model. Totally, the two-part parametric regression model is a simple and available model which can be easily interpreted; on the other hand, though the single-index two-part semi-parametric model cannot be easily interpreted, it has considerable flexibility. The study goals can be indeed used as me main factor for choosmg one of these two models

Exposure to extremely low frequency electromagnetic fields during pregnancy and the risk of spontaneous abortion: a case-control study

Exposure to extremely low frequency electromagnetic fields is increasingly common, but the potential influence on pregnant women has not been thoroughly investigated. In this case-control study, 58 women who had an unexplained spontaneous abortion at < 14 weeks gestation and 58 matched pregnant women >14 weeks gestation were enrolled in 2012. The women completed the questionnaire, which was used to collect data about socioeconomic and obstetric characteristics, medical and reproductive histories. Then, to evaluate the extremely low frequency electromagnetic fields, we determined the magnitude of electromagnetic fields in the participants' houses by an exposure level tester [3D EMF tester/ Model: ELF-828; Taiwan].The instrument covers a limited frequency range [30 HZ to 3 KHZ]. The magnitude of extremely low frequency electromagnetic fields in the participants' houses was significantly different between the two groups [P<0.001]. Extremely low frequency electromagnetic fields exposure is probably related to early spontaneous abortions

Motor skill competence and perceived motor competence: which best predicts physical activity among girls?

The main purpose of this study was to determine which correlate, perceived motor competence or motor skill competence, best predicts girls' physical activity behavior. A sample of 352 girls [mean age=8.7, SD=0.3 yr] participated in this study. To assess motor skill competence and perceived motor competence, each child completed the Test of Gross Motor Development-2 and Physical Ability sub-scale of Marsh's Self-Description Questionnaire. Children's physical activity was assessed by the Physical Activity Questionnaire for Older Children. Multiple linear regression model was used to determine whether perceived motor competence or motor skill competence best predicts moderate-to-vigorous self-report physical activity. Multiple regression analysis indicated that motor skill competence and perceived motor competence predicted 21% variance in physical activity [R[2]=0.21, F=48.9, P=0.001], and motor skill competence [R[2]=0.15, beta=0.33, P= 0.001] resulted in more variance than perceived motor competence [R[2]=0.06, beta =0.25, P=0.001] in physical activity. Results revealed motor skill competence had more influence in comparison with perceived motor competence on physical activity level. We suggest interventional programs based on motor skill competence and perceived motor competence should be administered or implemented to promote physical activity in young girls

Body image satisfaction and self-esteem status among the patients with polycystic ovary syndrome

Most previous research has focused on polycystic ovary syndrome [PCOS] characteristics and their association with psychological disorders, such as anxiety and depression. In the present study, our aim was to study whether PCOS characteristics are associated with several aspects of psychological well-being namely self-esteem and body satisfaction. This was a cross-sectional study of 300 women with PCOS that was carried out in Kashan, Iran. Main outcome measures were the Body Image Concern Inventory [BICI] and the Rosenberg's Self-Esteem Scale and clinical information of PCOS. Major clinical PCOS features including obesity [BMI], excessive body hair [hirsutism score], acne, menstrual cycle disturbances and infertility. The findings of regression analysis indicated that infertile women had lower levels of self-esteem [beta=-0.11, p=0.049] and poorer body satisfaction [=0.121, p=0.036] compared with PCOS women without infertility. Furthermore, hirsute women experienced poorer self-esteem than women without hirsutism [beta=-0.124, p=0.032]. Women with menstrual irregularities had higher body dissatisfaction [beta=0.159, p=0.005]. Moreover, women with higher body mass index scores had poorer body satisfaction [beta =0.151, p=0.009] but were not associated with self-esteem. The emotional well-being of the patients presenting with the syndrome needs to be recognized more fully, particularly in relation to the low self-esteem, poor body image, and struggles with weight, menstrual irregularities, hirsutism and infertility. The results of this study raise implications for clinical practice and suggest that a multidisciplinary approach to the management of women with PCOS

impact of maternal age, pre-pregnancy body mass index, weight gain and parity on glucose challenge test [GCT]

Background: Gestational diabetes mellitus [GDM] complicates 3-7% of all pregnancies and feto-maternal outcomes are strongly related to early diagnosis of GDM. The aim of this study was to determine the impact of risk factors in the prediction of an abnormal glucose challenge test [GCT]

Materials and Methods: This was a prospective study conducted during 2009-2010 in two prenatal clinics in Rey, Iran. A total of 711 pregnant women who were in their first trimester of pregnancy and met the inclusion criteria were selected. The women were observed once every other week until 24-28 weeks of gestation. All patients at 24-28 weeks of gestation were screened with 50 g oral glucose GCT. The effects of pre-pregnancy body mass index [BMI], maternal age, and weight gain until the time of GCT, and parity on abnormal GCT were evaluated. All confident intervals were calculated at the 95% level. Data was analyzed using student's t test and the logistic regression test

Results: Maternal age [p<0.001], pre-pregnancy BMI [p<0.00], parity [p=0.05] and weight gain during pregnancy [p=0.05], were significantly higher in women with abnormal GCT compared to women who had normal GCT. Logistic regression analyses confirmed that pre-pregnancy BMI [OR=1.09], maternal age [OR=1.14], and weight gain during pregnancy [OR=1.13] were associated with abnormal GCT

Conclusion: Weight gain had a profound impact on the prevalence of abnormal GCT in our population. Therefore, we propose that pregnant women should only gain the recommended amount of weight during pregnancy

Survival estimating following recurrence in gastric cancer patients and its relative factors

Gastric cancer [GC] is one of the most common cancers in the world. Despite of improvements in cancer treatment, survival rate of these patients is low. There are various factors that influence on the recurrence. The aim of this study was to assess the survival of the gastric cancer patients with relapse and determine the related risk factors. A total of 93 gastric cancer patients with relapse who entered from 21 March 2003 to 21 March 2007 to the cancer institute of Imam Khomeini Hospital [Tehran] were surveyed in this study. The survival time was considered monthly from the time of cancer diagnosis up to death or end of study. The effect of various risk factors such as gender, diagnosis age, tumor site, pathologic stage of disease, type of treatment, degree of differentiation on survival patients after relapse are considered in this study. From 93 patients with relapse, 79.6% were men. 48.4% of patients were died during their follow up. The mean age from diagnosis to relapse was 15.7 +/- 11.7 and half of the patients experienced relapse 11 months after the treatment. Survival mean and median were 14.5 and 9 months respectively. One, three and five year survival of the patients was 0.42, 0.19 and 0.13 respectively. Pathologic stage, age at diagnosis, degree of differentiation and using radiography were significantly related to the survival. Half of the patients experienced relapse in the first year following their treatment. Thus, monthly referral of patients is necessary for timely diagnosis

[Study about the effects of rehabilitation on quality of life in multiple sclerosis patients]

Multiple sclerosis is a progressive demyelization disease which can progress to physical disability in many patients. People with multiple sclerosis face many problems and complications which require appropriate education and interventions. Multidisciplinary neurorehabilitation is an effective treatment for quality of life improvement in MS patents. The purpose of this study is to examine the effect of Hayate Noo center rehabilitation protocol on quality of life of MS patents. In this clinical trial 130 MS patients [65 patients as treatment group and 65 as control group] were studied. Participants were randomly selected from patients attending Iran MS society in Tehran. The two groups were matched in terms of sex, age and education, type of MS, marital status, time of onset of MS, and disability status. A questionnaire was used for data collection. The questionnaire consisted of three parts .Part one is demographics information and the 2[nd] part consisted of Persian version of MSQOL-54 questionnaire. This questionnaire has been translated and validated in previous studies, with 0.96 coefficient [alpha cronbach] reliability. The 3rd part included Persian version of PDDS questionnaire .This test is designed to measure the disability status and has a correlation coefficient of 0.80 [spearman correlation] with EDSS [expanded disability status scale]. Patients in treatment group participated in the multidisciplinary rehabilitation protocol. This protocol was designed in Hayate Noo center. Each patient in treatment group attended in at least 8 sessions of Hayate Noo multidisciplinary neurorehabilitation protocol for 3 months. All participants were assessed in terms of their disability status prior to the study. Participants in both groups completed MSQOL-54 before and after the study. The data were analyzed using SPSS software, version 16. Student t-test was used to compare means and Pearson correlation coefficient was used for measuring the correlations. Changes in Quality of life scores in treatment group were statistically significant [p<005]. Scores of all subscales in Quality of life measure [except for cognitive domain] increased in treatment group compared with the control group. Physical health composite score increased 8.04 point and mental health composite score improved 7.7 point [P<0.001]. Also the social activity of treatment group increased comparing with the control group. Use of Hayateno center protocol has increased quality of life scores in MS patients. This improvement is comparable with another center in the world