Study of baseline echocardiography and treatment endpoint in patients with acute lymphoblastic leukemia.

INTRODUCTION: Acute lymphoblastic leukemia (ALL) is the most common malignancy in children. Anthracyclines are among the most common and effective drugs for the treatment of children ALL. However, long-term consumption and higher doses of these drugs may lead to toxic effects on the heart of children. For this purpose, in the present study, the baseline and posttreatment echocardiography status was evaluated in children with ALL during 7 years. MATERIALS AND METHODS: This retrospective cross-sectional study was performed on 53 children with ALL who were under the age of 18 years. Different factors including risk groups, age, gender, white blood cells, dosage, and duration of treatment, as well as baseline and posttreatment echocardiography findings including EF, E/E/, E//A/, MVE/A were evaluated in all patients. RESULTS: All enrolled patients had not any abnormalities in the baseline echocardiography preventing the beginning of chemotherapy. The results of this study did not show a significant difference in mean baseline echocardiography parameters after treatment including EF̨E/E/˛E//A/˛, MVE/A. In addition, there was no significant difference in mean EF, E//A/˛, MVE/A, and ˛E/E/ before and after treatment among SR, IR, and HR groups. Although there was no significant difference in the mean EF, E//A/, and MVE/A before and after treatment between male and female sex, the mean E/E/ after chemotherapy in girls (8.5 ± 0.7) was significantly higher than the mean before treatment (6.85 ± 1.5) (P < 0.001). It was also higher than the mean in boys (7.04 ± 0.99) (P = 0.019). Although there was no significant relationship between the duration of chemotherapy and the mean of EF̨E/E/˛E//A/˛, MVE/A after treatment, high dose of the drug was found to be significantly associated with a gradual decrease of EF or systolic function of the heart (P < 0.001). There was no significant relationship between drug dose and other parameters of echocardiography including E/ A/, MVE/A, and E/E/ after treatment. CONCLUSION: It appears that chemotherapy should not be delayed by echocardiography. Based on the findings presented herein, increasing the dose of anthracycline can be considered as an effective factor in reducing the systolic function of the heart (EF reduction). On the other hand, chemotherapy in the period of 1 to 5.3 years does not seem to have a significant effect on the mean parameters of EF, E/E/, E//, and MVE/A although another study with higher sample size and follow-up is needed to confirm these results.

Evaluation of an undergraduate occupational health program in Iran based on alumni perceptions: a structural equation model.

PURPOSE: Evaluating educational programs can improve the quality of education. The present study evaluated the undergraduate occupational health program at the Semnan University of Medical Sciences in Semnan, Iran, with a focus on the associations between alumni perceptions of the learning environment and the outcomes of the occupational health program. METHODS: A cross-sectional questionnaire survey was conducted among alumni of the undergraduate occupational health program. We asked alumni to rate their perceptions of the items using a 4-point Likert scale. The associations between alumni perceptions of the educational program and curriculum, faculty, institutional resources, and learning outcomes were modeled and described using structural equation modeling procedures. RESULTS: A descriptive analysis of alumni perceptions indicated low evaluations for the administrative system, practical and research-based courses, and the number of faculty members. We found that a structural model of the evaluation variables of curriculum, faculty qualifications, and institutional resources significantly predicted undergraduate educational outcomes. The curriculum had direct and indirect effects on learning outcomes, mediated by faculty. CONCLUSION: The findings of our study highlight the usefulness of the structural equation modeling approach for examining links between variables related to the learning process and learning outcomes. Surveys of alumni can provide data for reassessing the learning environment in the light of the professional competencies needed for occupational health graduates.

Structural equation model of interactions between risk factors and work-related musculoskeletal complaints among Iranian hospital nurses.

BACKGROUND: Statistics indicate a high risk of developing work-related musculoskeletal disorders among hospital nurses. The challenge is to understand the associations between musculoskeletal symptoms and various individual and occupational risk factors. OBJECTIVE: This study examined the direct and indirect interactions of various risk factors with musculoskeletal complaints in hospital nurses. METHOD: In a cross-sectional design, Iranian hospital nurses from Semnan University of Medical Sciences participated in a questionnaire survey reporting their perceived perceptions of various work-related risk factors and musculoskeletal symptoms. We tested our proposed structural equation model to evaluate the relations between latent and observed concepts and the relative importance and strength of exogenous variables in explaining endogenous musculoskeletal complaints. RESULTS: Measurement model fits the data relatively acceptable. Our findings showed direct effects of psychological, role-related and work posture stressors on musculoskeletal complaints. Fatigue mediated the adverse indirect relations of psychological, role-related, work posture and individual factors with musculoskeletal complaints. CONCLUSIONS: Structural equation modeling may provide methodological opportunities in occupational health research with a potential to explain the complexity of interactions among risk factors. Prevention of work-related musculoskeletal disorders among nurses must account for physical and psychosocial conditions.

Incorporation of project-based learning into an occupational health course.

OBJECTIVE: Use of an appropriate teaching approach is a major concern for faculty members who are involved in occupational health and safety academic education. The challenge is to explore teaching tools to equip students with knowledge and skills to prepare them for their practices, in which they will encounter occupational health and safety issues in various occupational settings. The current study presents the design and implementation of a team project-based learning approach for undergraduate occupational health students to examine the appropriateness and perceptions of students and educators with regard to such a learning experience. METHODOLOGY: Steps were taken to guide the educators and students through the learning process based on projects completed in teams. The research tools for collecting data were a questionnaire and semi-structured interviews with participants. RESULTS: The results illustrated that use of the proposed teaching approach as part of occupational health education may have the potential to motivate and enhance the active roles of educators and students in the learning process, and improve students' technical and social skills that are crucial for practice in the occupational health field. CONCLUSIONS: The study findings showed that project-based learning may provide a promising teaching strategy in the education and training of occupational health students. In addition, academic institutions should encourage educators to plan, introduce and evaluate the effectiveness of project-based learning.

Echocardiographic evaluation of systolic and diastolic heart function in patients suffering from beta-thalassemia major aged 5-10 years at the Zahedan Research Center for Children and Adolescent Health.

OBJECTIVE: Cardiac complications are the major cause of morbidity and mortality in beta-thalassemia major. The aim of the study was to evaluate right (RV) and left (LV) ventricular systolic and diastolic functions using myocardial performance index in young, asymptomatic children suffering from thalassemia major, for early detection of cardiac function impairment, preventing further cardiac damage by modifying disease progression and treatment. METHODS: A case-controlled, cross-sectional study involving 80 patients suffering from beta- thalassemia major and 80 children adjusted in terms of age and sex served as a control group were studied in Research Center for Children and Adolescent Health Zahedan. The relevant echocardiographic parameters were measured in both subject groups: myocardial performance index (MPI), isovolumic relaxation time (IRT), isovolumic contraction time (ICT), pre-ejection period (PEP), ejection time (ET), PEP/ET ratio, deceleration time (DT) and acceleration time (AT). Data were analyzed by unpaired Student t test. RESULTS: The left ventricular mean IRT in the patient group was 114+/-21 and in the control group 94+/-10 msec (p=0.05). The mean MPI (LV) in the patient group was 0.58+/-0.18 and in the control group 0.41+/-0.08 (p=0.05). The mean ET (LV) in the patient group was 237+/-36 msec and in the control group 266+/-25 msec (p=0.05). The mean ET (RV) in the patient group was 237+/-39 msec and in the control group 261+/-36 msec (p=0.05). CONCLUSION: There is an early systolic and diastolic dysfunction in children younger than 10 years with beta-thalassemia major. Even in young asymptomatic children with beta-thalassemia major, serial echocardiography seems warranted in order to adjust cardioprotective therapy.

Assessment of right ventricular function in children with congenital heart disease. Doppler tissue imaging.

OBJECTIVE: To assess right ventricular dysfunction in children with congenital heart disease (CHD) by measurement of tricuspid annular diastolic velocity Aa/Ea ratio by doppler tissue imaging (DTI). METHODS: A case-control study was performed on 141 children with CHD who were referred to Aliasghar Hospital of Zahedan, Iran for cardiac catheterization from April 2004 to December 2005. Tricuspid inflow velocity (A/E ratio) and Aa/Ea ratio was measured by DTI. Patients were catheterized afterwards. Cumulative data were analyzed by Statistical Package for Social Sciences and evaluated using t-test and correlation. RESULTS: There was significant correlation between Aa/Ea ratio by DTI, and hemodynamic criteria derived at catheterization. It was also diagnosed that 77 patients of 141 had right ventricular dysfunction by DTI, whereas 74 of them showed this problem at catheterization. The sensitivity of this method for evaluation of right ventricular dysfunction was 95%, and specificity was 98%. The positive predictive value 95%, and negative predictive value 98% were assessed. CONCLUSION: Finding of this study showed that we can use DTI for diagnosis of right ventricular dysfunction in children with CHD, and it can be used instead of catheterization especially in unstable patients.