[Survival analysis of the patients with Thalassemia major using parametric and semi parametric survival models]

Introduction: thalasemia Major is one of the most common anemia diseases that can be fatal if not promptly diagnosed. The survival analysis of these patients can be an appropriate strategy in determining risk factors for death in these patients. The purpose of this study was to choose the best model to determine the risk factors for death in patients with the thalasemia major using common methods in the survival analysis

Methods: the data of this retrospective cohort study, with 296 patients with thalassemia major, was collected in 2004- 2013 in Zafar Clinic in Tehran. Akaicke information Criterion was used for comparison of the models and the choice 351of the best model. Data analysis was carried out with R3.0.2 software at the significant level of 0.1

Results: the values of the Akaicke information criterion [AIC] for the parametric weibull, frailty weibull, log-normal, log-logistic, Gompertz, gamma and the semiparametric Cox were computed and found to be 27.56, 29.56, 18.73, 23.39, 26.26, 68.10, 24.73, respectively. The mean survival time for men and women were 40.2 and 39.7 years, respectively. The Log-normal model showed that age, age at the first desferal injection, onset of blood injection, the patient's birthplace, mother's education variables were significantly correlated with patient survival

Conclusion: according to the values of AIC, the parametric log-normal model was chosen and suggested as the best model

[The impact of accreditation on productivity indexes in Firoozgar Hospital in Tehran]

Introduction: accreditation, as an international diagnostic evaluation process, can improve productivity indexes through enhancing medical service quality. The current study aimed to assess the impact of accreditation on productivity indexes in Firoozgar hospital in Tehran

Methods: this practical, analytical-interventional and cross-sectional study was conducted during 2011-2012 in Firoozgar hospital in Tehran. Data forms were used for collecting data which were then analyzed using SPSS and R [Ver. 3.0.1] and the statistical methods employed were ratio and paired-t tests

Results: productivity indexes were studied based on four axes which included eleven ratios. Based on the findings, accreditation had a significant impact on income-expense axis, a relative influence on performance indexes axis and specific unit axis and no impact on human resource axis

Conclusion: considering the relative impact of accreditation on the improvement of hospital productivity indexes, it can be concluded that it lead to more quality services to patients and decrease many problems in this section. Therefore, managers are recommended to implement it in their hospitals

[Related factors with obesity in Tehranian households: a cross-sectional study]

In 21[st] century obesity has rapidly increased and it has become one of the greatest public health problems worldwide. The aim of this study was to determine related factors with obesity in Tehranian households. In this descriptive study, multivariate analysis was used to estimate the odds of obesity [BMI >/= 30 kg/m2] as a function of age, sex, marital status, educational level and smoking by using data from" Tehran Lipid and Glucose Study [TLGS]" database. In this study 3,935 households participants who were equal or more than 20 years old, were recruited from phase III [2006-2008] of this study. Height of participants was measured to the nearest 5 mm without considering their shoe heels. Weight and height were measured using digital electric scale and meter tape. Data were analyzed by SPSS/16 and SAS version 9.1. The mean BMI was 26.59 [kg/m[2]] in men and 27.96 [kg/m[2]] in women. After adjustment for other variables, obesity odds ratios were 1.01 [P<0.001], 2.10 [P<0.001], and 1.54 [P<0.001] for age, women and married individuals, respectively. There was an inverse significant association between education and obesity. Obesity ORS were 0.83 [P<0.028] for high school and 0.50 [P<0.001] for university educational levels. The results of this study show that related factors in this research are similar to other countries. Therefore, obesity with related factors should be considered in health programming

Application of artificial neural network in predicting the survival rate of gastric cancer patients

The aim of this study was to predict the survival rate of Iranian gastric cancer patients using the Cox proportional hazard and artificial neural network models as well as comparing the ability of these approaches in predicting the survival of these patients. In this historical cohort study, the data gathered from 436 registered gastric cancer patients who have had surgery between 2002 and 2007 at the Taleghani Hospital [a referral center for gastrointestinal cancers], Tehran, Iran, to predict the survival time using Cox proportional hazard and artificial neural network techniques. The estimated one-year, two-year, three-year, four-year and five-year survival rates of the patients were 77.9%, 53.1%, 40.8%, 32.0%, and 17.4%, respectively. The Cox regression analysis revealed that the age at diagnosis, high-risk behaviors, extent of wall penetration, distant metastasis and tumor stage were significantly associated with the survival rate of the patients. The true prediction of neural network was 83.1%, and for Cox regression model, 75.0%. The present study shows that neural network model is a more powerful statistical tool in predicting the survival rate of the gastric cancer patients compared to Cox proportional hazard regression model. Therefore, this model recommended for the predicting the survival rate of these patients

Risk factors associated with cerebral palsy in children born in eastern and northern districts of Tehran

Cerebral palsy is a group of non-progressive motor impairment syndromes caused by lesions of the brain arising early in development. In this study, we evaluated perinatal risk factors of children born in eastern and northern districts of Tehran city, when perinatal records were widely available. This was a case-control study performed on one to six year-old children living in Tehran, at healthcare centers of Shahid Beheshti University of Medical Sciences and Asma Rehabilitation Center, over 12 months. During the study period, 112 subjects in the case and 3465 in the control groups were studied. The main factors associated with cerebral palsy were [odds ratios, confidence interval]: neonatal convulsion [81.35, 35.09-188.6], low Apgar score [<5] at 5 min or beyond [21.83, 13.13-36.26], low birth weight [5.83, 3.47-9.77], mother's complication during pregnancy [7.83, 4.23-14.50] and maternal age over 35 years [3.88, 2.03-7.42]. Neonatal encephalopathy, low birth weight, and high risk pregnancy were the most powerful independent predictors of cerebral palsy in this population. The majority of infants with cerebral palsy were born at term; therefore, cerebral palsy is quantitatively mainly an issue of term infants

[Comparison of artificial neural network and parametric regression models in survival prediction of patients with gastric cancer]

Using parametric models is common approach in survival analysis. In the recent years, artificial neural network [ANN] models have increasingly used in survival prediction. The aim of this study was to predict of survival rate of patients with gastric cancer by using a parametric regression and ANN models and compare these methods. We used the data of 436 gastric cancer patients from a cancer registry in Tehran between 2002-2007. All patients had a confirmed diagnosis. Data were randomly divided into two groups: training and testing [or validation] set. For analysis of data we used a parametric model [exponential, Weibull, normal, lognormal, logistic and log-logistic models] and a three layer ANN model. In order to compare of the prediction of two models, we used the area under receiver operating characteristic [AUROC] curve, classification table and concordance index. The prediction accuracy of the ANN and the parametric [Weibull] models were 79.45% and 73.97% respectively. The AUROC for the ANN and the Weibull models were 0.815 and 0.748 respectively. The ANN had a better predictions than the Weibull model. Thus it is suggested to use of the ANN model survival prediction in field of cancer

[Effect of group play therapy on depression in children with cancer]

Children with cancer develop depression which can lead to several problems in the course of treatment. The aim of play therapy was to reduce depression and produce positive results in the health status of these children. This was an experimental study and included all 6-15 years old children with cancer in Mahak center in 2007. After calculating the depression score by means of Child Depression Scale-A [CDS-A], 24 patients who were depressed and had scores of more than 84, were randomly assigned into experimental and control groups. Play therapy was performed for seven 2-hour sessions for experimental group. The groups were assessed for depression again after one week. Data were introduced into SPSS software and analyzed by means of Manwitny-U and Wilcoxon, and Kruskal-Wallis tests. The results of this study showed that the mean values of depression scores in experimental and control groups were 95.21 and 91.75 before play therapy, and 74.33, and 94.08 after play therapy respectively, which was statistically significant [p= 0.002]. The results indicated that play therapy led to significant improvement of depression and may be an effective intervention for children with cancer. Play therapy can be an effective intervention to help the hospitalized children in order to prepare them for painful therapeutic procedures and stress of hospitalization

[Study of awareness towards and the pattern of milk consumption in 7-12 year old elementary school students in the city of Sari and their mothers [2005-2006]]

Today, most societies face significant decrease in consuming milk products in children and this process would cause problems in providing the calcium needed by children, particularly since the osteoporosis is definitely connected to a lack of receiving sufficient calcium in children and adolescence age. Therefore, the goal of this study is to study the knowledge and pattern of milk consumption in 7-12 year old children of Sari and their mothers. The research samples consisted 638 male and female student at 7-12 in elementary schools [urban and rural], chosen at random from 16 schools. Necessary data were obtained through separate and different questionnaires on the output of milk consumption and its products through direct interviews. The data of the study were analyzed using t-Test, ANOVA, Duncan follow up, Chi-square and correlation coefficient. In this study, 44% of children and 37.7% of mothers consumed milk and 50.1% of children and 19.4% mothers sometimes consumed milk. 5.5% of children and 19.4% of mothers did not consume milk. Mostly, the reason for non-consuming milk among children and mothers was: not having access to milk [27.9% and 17.7%]. The awareness towards the advantages of milk was desirable in 67% children and 48.7% of mothers. It was almost desirable in 21.1% children and 4.5% of mothers and undesirable in 1.4% of children and 1.1% of mothers. The amount of milk consumption for 62% of urban children and 49% of rural children was only one unit, and, in sum, the amount of milk consumption for 59% of boys and 55% of girls was less than the recommended figures. The mean average of criteria deviation in the amount of milk consumption for children showed a significant difference from their educational levels [p=0.001] and insignificant difference from their sex. In addition, the pattern of milk consumption of children had significant relationship with the sex, education level and education of father; however, it had significant relationship with the education level of mothers and the jobs of mother and father. Children's knowledge about the advantages of milk had a significant relationship with the education level of mothers, fathers and jobs of mothers [P<0.004]; however, it had a insignificant relationship with their sex. In this study, the amount of milk consumption in half of the population subjects of the study was less than the standard recommended amount; therefore, to improve children's health status and prevent the destructive effects of osteoporosis in adulthood, there should be necessary actions to increase milk consumption among children

[Impact of training communication skills to nurses on patients' satisfaction with nurse-patient relationship]

One of the most important factors in increasing patient satisfaction and improving healthcare outcomes is appropriate nurse-patient relationship. This quasi-experimental study was performed to determine the impact of training communication skills to nurses on patients' satisfaction with nurse-patient relationship. All 60 nurses working in medical and infection wards of Imam Khomeini and Vali-e-Asr hospitals were chosen and were divided into two control and experimental groups. Similarly, 80 patients were chosen from the same wards by convenience sampling and divided into two control and experimental groups at each stage of the study. A questionnaire was used for gathering data collected before and 1 month after the intervention. After the first stage, nurses in the experimental group took part in communication-skill workshop for two days, each lasted 8 hours. Findings showed a significant difference between patients' satisfaction before and after the intervention in the experimental group [P<0.001]. There was also a significant difference in patients' satisfaction after instruction between experimental and control groups [P<0.001]. It can be concluded that communication skill training in nurses has positive effects on patients' satisfaction. Thus, communication skill training programs is recommended for nurses to improve the quality of nursing care and increase patients' satisfaction