The Relationship between Mortality of Lung Transplant Recipients and Serum Cyclosporine Levels: Joint Modeling of Time-to-Event Data and Longitudinal Data.

BACKGROUND: Lung transplantation (LTx) is a well-accepted treatment that can prolong survival of patients with advanced lung disease. OBJECTIVE: To evaluate the association between serum cyclosporine level (SCL) pattern and mortality of LTx recipients. METHODS: This retrospective cohort study included 1019 observations on 38 patients who underwent LTx in Masih Daneshvari Hospital from 2000 to 2013. The analysis applied a joint model with shared random effects. RESULTS: The mean±SD age of the recipients was 36±14.5 years. The findings indicated that sex, age, body mass index (BMI), the underlying disease, and cytomegalovirus infection were not associated with mortality. The mortality risk for the recipients with acute rejection (AR) history was 1.54 times that of the recipients who had none (95% CI: 1.08-2.19). The association parameter in the joint model (α = 0.8) showed that higher SCL was associated with lower mortality risk (95% CI: 1-1.011). A slightly linear decreasing trend in SCL mean was found after 10 months post-LTx; a significant 2% per month (95% CI: -0.03 to -0.019). CONCLUSION: AR history was found to be a risk factor in mortality in Iranian LTx recipients. Given the association between the higher SCL and lower mortality found in this study, it is recommended to pay serious attention to SCL changes in the overall post-transplantation survival assessment in Iranian LTx recipients.

Psychometric properties of the Social Cognitive Theory questionnaire for physical activity in a sample of Iranian adolescent girl students.

This research examined the validity and reliability of a researcher-developed questionnaire based on Social Cognitive Theory (SCT) to assess the physical activity behaviour of Iranian adolescent girls (SCT-PAIAGS). Psychometric properties of the SCT-PAIAGS were assessed by determining its face validity, content and construct validity as well as its reliability. In order to evaluate factor structure, cross-sectional research was conducted on 400 high-school girls in Tehran. Content validity index, content validity ratio and impact score for the SCT-PAIAGS varied between 0.97-1, 0.91-1 and 4.6-4.9 respectively. Confirmatory factor analysis approved a six-factor structure comprising self-efficacy, self-regulation, family support, friend support, outcome expectancy and self-efficacy to overcoming impediments. Factor loadings, t-values and fit indices showed that the SCT model was fitted to the data. Cronbach's α-coefficient ranged from 0.78 to 0.85 and intraclass correlation coefficient from 0.73 to 0.90.

Predictors of Iranian women's intention to first papanicolaou test practice: An application of protection motivation theory.

BACKGROUND AND AIM: Given the importance of papanicolaou (Pap) test in the early detection and timely treatment of cervical cancer, present study was designed to determine predictors of a sample of Iranian women's intention to first Pap test practice based on the protection motivation theory (PMT) variables. MATERIALS AND METHODS: In this cross-sectional study, a total of 240 women referral to the 30 primary health care clinics were selected. They completed a developed scale based on PMT variables including intention, perceived vulnerability and severity, fear, response costs, response efficacy and self-efficacy. Path analysis was used to determine the association between predictive factors and intention. RESULTS: The results showed that PMT had goodness of fit with a χ2/df = 2.37, df = 28, P= 0.001 and RMSEA = 0.076. PMT explained 42% of the variance in women's intention to get first Pap smear test. Self-efficacy (b = 0.55, P< 0.001) and response efficacy (b = 0.19, P< 0.001) were found to be the predictors of intention. CONCLUSION: These findings may be used to develop tailored, theory-based educational interventions associated with Pap testing among women.

Psychometric properties of the Social Cognitive Theory questionnaire for physical activity in a sample of Iranian adolescent girl students

This research examined the validity and reliability of a researcher-developed questionnaire based on Social Cognitive Theory [SCT] to assess the physical activity behaviour of Iranian adolescent girls [SCT-PAIAGS]. Psychometric properties of the SCT-PAIAGS were assessed by determining its face validity, content and construct validity as well as its reliability. In order to evaluate factor structure, cross-sectional research was conducted on 400 high-school girls in Tehran. Content validity index, content validity ratio and impact score for the SCT-PAIAGS varied between 0.97-1, 0.91-1 and 4.6-4.9 respectively. Confirmatory factor analysis approved a six-factor structure comprising self-efficacy, self-regulation, family support, friend support, outcome expectancy and self-efficacy to overcoming impediments. Factor loadings, t-values and fit indices showed that the SCT model was fitted to the data. Cronbach's alpha-coefficient ranged from 0.78 to 0.85 and intraclass correlation coefficient from 0.73 to 0.90

La présente étude visait à examiner la validité et la fiabilité d'un questionnaire mis au point par des chercheurs, basé sur la TSC, et visant à évaluer le comportement de jeunes adolescentes iraniennes en matière d'activité physique. Les propriétés psychométriques du questionnaire de TSC pour l'activité physique dans un échantillon de jeunes élèves filles iraniennes ont été évaluées en déterminant sa validité apparente, sa validité de contenu et de construit, ainsi que sa fiabilité. Afin d'évaluer la structure factorielle du questionnaire, une étude transversale a été conduite auprès de 400 lycéennes à Téhéran. L'index et le radio de validité de contenu, ainsi que le score d'impact du questionnaire de TSC pour l'activité physique dans un échantillon de jeunes élèves filles iraniennes, variaient de 0,97 à 1, de 0,91 à 1 et de 4,6 à 4,9 respectivement. L'analyse factorielle confirmatoire a validé une structure factorielle comprenant 6 aspects : l'auto-efficacité, l'auto-régulation, le soutien familial, le soutien social, l'attente du résultat et l'auto-efficacité pour dépasser les obstacles. La saturation factorielle, les valeurs de t et les indices d'ajustement ont montré que le modèle d'évaluation de la TSC était adapté aux données. Le coefficient alpha de Cronbach était compris entre 0,78 et 0,85 et le coefficient de corrélation intraclasse entre 0,73 et 0,90

Psychometric properties of the Persian version of the Sexual and Reproductive Health Needs Assessment Questionnaire.

No tools to assess women's general sexual and reproductive health needs have been validated in the Iranian context. This study in Sari in Mazandaran province of the Islamic Republic of Iran was conducted to evaluate the psychometric properties of a Persian version of the Sexual and Reproductive Health Needs Assessment Questionnaire (first developed for the International Organization for Migration and United Nations Population Fund). The Persian version of the questionnaire was found to have adequate face and content validity (quantitative and qualitative) for assessing sexual and reproductive health needs among women (content validity index = 0.88). The test-retest reliability showed that, except for the domain of sexually transmitted infections, all domains of the questionnaire had an acceptable reliability (intra-class correlation coefficients > 0.5). This questionnaire is a valid tool for assessing the sexual and reproductive health needs of Iranian women and planning/designing strategies to meet them.

Why Iranian adolescents do not brush their teeth: a qualitative study.

OBJECTIVES: To explore and describe attitudes towards tooth-brushing among Iranian adolescents. METHODS: A series of focus-group sessions were held with 37 Iranian adolescents in schools. The groups comprised five to eight adolescents. All focus-group discussions were tape-recorded and then transcribed verbatim. All transcripts, codes and categories were read several times to extract a theme. Data were analysed using a qualitative content analysis approach. RESULTS: Four major categories emerged from the analysis: brushing teeth is a necessary evil, parental influence on not brushing teeth, brushing teeth is insignificant, and brushing teeth is a health hazard. The theme identified in the latent content described that tooth-brushing is not part of the adolescents' activities of daily living. CONCLUSIONS: Health educators should stress on the engagement of parents, awareness of the adolescents on brushing techniques and causes of toothache, and address any misconceptions regarding tooth-brushing.

Comparison of maternity care quality in teaching and non-teaching hospitals in Khorram Abad, Islamic Republic of Iran.

The objective of this study was to compare the quality of maternity care in 2 types of government-run hospital in the town of Khorram Abad, Islamic Republic of Iran in 2009: a university-linked teaching and a social security organization non-teaching hospital. A sample of 264 women hospitalized in the delivery and postpartum wards was selected. Data collection was done using interviews with mothers and observation checklists based on Iranian government criteria. The quality of maternity care in the non-teaching hospital was higher than the teaching hospital in terms of facilities, processes of maternal and newborn care and outcomes (mother's satisfaction). In the teaching hospital, the quality of the physical space, the educational level and training of health care personnel and monitoring and evaluation of care quality needed improvement. In both hospitals, meeting women's expectations about the degree of privacy could lead to an increase in the quality of maternity services.

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

BACKGROUND: 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. METHODS: 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. RESULTS: 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%. CONCLUSION: 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.

Comparison of maternity care quality in teaching and non-teaching hospitals in Khorram Abad, Islamic Republic of Iran

The objective of this study was to compare the quality of maternity care in 2 types of government-run hospital in the town of Khorram Abad, Islamic Republic of Iran in 2009: a university-linked teaching and asocial security organization non-teaching hospital. A sample of 264 women hospitalized in the delivery and postpartum wards was selected. Data collection was done using interviews with mothers and observation checklists based on Iranian government criteria. The quality of maternity care in the non-teaching hospital was higher than the teaching hospital in terms of facilities, processes of maternal and newborn care and outcomes [mother's satisfaction]. In the teaching hospital, the quality of the physical space, the educational level and training of health care personnel and monitoring and evaluation of care quality needed improvement. In both hospitals, meeting women's expectations about the degree of privacy could lead to an increase in the quality of maternity services

Site-specific evaluation of prognostic factors on survival in Iranian colorectal cancer patients: a competing risks survival analysis.

BACKGROUND: Colorectal cancer (CRC) is one of the most malignant cancers, but prognosis varies in different parts of the world. Knowing the prognostic factors of the cancer is clinically important for prognosis and treatment application objectives. However, evaluation of these factors overall does not provide thorough understanding of the cancer. Therefore, this study aimed to evaluate prognostic factors of colon and rectal cancers site-specifically, via a competing risks survival analysis with colon and rectum as competing causes of death. METHODS: A total of 1,219 patients with CRC diagnosis according to the pathology reports of our cancer registry, from 1 January 2002 to 1 October 2007, were entered into the study. Demographic and clinicopathological factors with regard to survival of patients were analyzed using univariate and multivariate competing risks survival analysis, utilizing STATA statistical software. RESULTS: The results of univariate analysis showed that gender, body mass index (BMI), alcohol history, inflammatory bowel disease (IBD), tumor size, tumor grade and pathologic stage were significantly associated with colon cancer and BMI, personal history of cancer, pathologic stage and the kind of first treatment used were significantly related to rectal cancer. In the multivariate analysis, BMI, IBD, tumor grade and pathologic stage of the cancer were significant prognostic factors for colon cancer and BMI and the kind of first treatment used were significant prognostic factors of rectal cancer. Also 1, 2, 3, 4 and 5 year and overall adjusted survival of patients with rectal cancer was better than those of colon cancer. CONCLUSION: Based on our findings, CRC is not a single entity and its sub-sites should be evaluated separately to reveal hidden associations which may not be revealed under general modeling.

Cultural barriers in the education of cardiovascular disease patients in Iran.

BACKGROUND: Cardiovascular diseases are responsible for the highest mortality rate in Iran; however, there is a lack of evidence for cultural factors influencing patient education. Such information is important for the provision of effective patient care. AIM: To identify key issues relating to cultural factors influencing education of cardiovascular disease patients in Iran. METHODS: The qualitative research approach was used in this study, with open-ended interviews used to gather data. Eighteen nurses, four cardiovascular specialists, nine patients with cardiovascular disease and four family members were interviewed at two educational hospitals in Tehran. Interviews were taped, transcribed and analysed using constant comparative analysis. FINDINGS: Participants expressed a range of cultural factors influencing patient education. Five themes emerged from the analysis: (a) patients' lifestyle, (b) beliefs about disease and treatment, (c) concealment of true diagnosis, (d) different opinions regarding the preferred instructor, and (e) ineffective communication. CONCLUSION: Findings show that cultural beliefs may act as risk factors for, or serve to intensify, cardiovascular disease. Consideration of these factors is essential for the success of patient education programmes.