Lifetime attributable cancer risk related to prevalent CT scan procedures in pediatric medical imaging centers.

PURPOSE: Evaluation of the organ dose in pediatric patients up to 15 years old and Estimation of lifetime attributable risk (LAR) of cancer incidence in pediatric computed tomography procedures. MATERIALS AND METHODS: Data from 532 patients below 15 years old was collected and they were categorized into four age groups of <1, 1-5, 5-10, and 10-15 years old. NCICT software was used to calculate the organ dose, and LAR of cancer incidence has been estimated according to the BEIR VII report. RESULTS: The highest median dose in all age groups was related to eye lens (head scan), thyroid (chest scan), and colon (abdomen-pelvic scan). The highest average LAR of cancer incidence was observed for breast cancer and colon cancer following a chest CT scan of the youngest group (<1-year-olds) [68.23 per 100,000] and abdomen-pelvic scans of the oldest group (10- to 15-year-olds) [57.30 per 100,000]. CONCLUSION: This study shows that the average LAR is higher in females and it decreases with age in both genders. Although CT scan has an indispensable application in diagnosis, the patient dose should be taken into account before any examination specifically in pediatric patients.

PEDIATRIC REGIONAL DRL ASSESSMENT IN COMMON CT EXAMINATIONS FOR MEDICAL EXPOSURE OPTIMIZATION IN TEHRAN, IRAN.

The main purpose of this pilot study was to assess the regional diagnostic reference level (RDRL) of computed tomography (CT) examinations to optimise medical exposure in five pediatric medical imaging centers in Tehran, Iran where the most frequent CT examinations were investigated. For each patient, CT volume dose indexes (CTDIvol) and dose length product (DLP) in each group were recorded and their third quartile was calculated and set as RDRL. Pediatrics were divided into four age groups (<1; 1-5; 5-10 and 10-15 years). Then, the third quartile values for head, chest and abdomen-pelvic CTs were, respectively, calculated for each group in terms of CTDIvol: 21.3, 24.4, 24.2 and 36.3 mGy; 2.9, 3.2, 3.7 and 5.7 mGy; 3.7, 5.7, 6.3 and 6.8 mGy; and in terms of DLP: 322.2, 390.1, 424.9 and 694.1 mGy.cm; 53.1, 115.2, 145.3 and 167.6 mGy.cm and 128.7, 317.7, 460.2 and 813.8 mGy.cm. Finally, RDRLs were compared with other countries and preceding data in Iran. As a result, CTDIVOL values were lower than other national and international studies except for chest and abdomen-pelvic values obtained in Europe. Moreover, this matter applied to DLP so that other formerly reported values were higher than the present study but European values for chest and abdomen-pelvic scans and also Tehran studies conducted in 2012. Variation of scan parameters (tube voltage (kVp), tube current (mAs) and scan length), CTDIvol and DLP of different procedures among different age groups were statistically significant (P-value < 0.05). The variations in dose between CT departments as well as between identical scanners suggest a large potential for optimization of examinations relative to which this study provides helpful data.

Comparison of SF-36 and WHOQoL-BREF in Measuring Quality of Life in Patients with Type 2 Diabetes.

OBJECTIVE: This study aimed to compare the quality of life (QoL) in patients with type 2 diabetes using two WHOQoL -BREF and SF-36 questionnaires in Iran. PATIENTS AND METHODS: In this cross-sectional study, 1847 patients with type 2 diabetes were recruited from rural health-care centers affiliated to Neyshabur County (Iran) in 2012. In addition to demographic information, two questionnaires WHOQoL-BREF and SF-36 questionnaires were used for data collection. Cronbach's alpha coefficient was used for scale reliability. We conducted an exploratory factor analysis for the investigation of construct validity. Convergent and discriminant validity were analyzed using Spearman correlation coefficient. To determine the relationships between the eight domains of SF-36 and four domains of the WHOQoL-BREF, structural equation modelling was performed. RESULTS: Cronbach's alpha coefficients were acceptable for all domains of both WHOQoL-BREF (0.69-0.86) and SF-36 (0.63 -0.92) questionnaires. The principal component analysis showed two separate factors: one for all domains of SF-36 and another for all domains of WHOQoL-BREF. Spearman correlation coefficients of both instruments were partly to strongly correlated with most domains (r ≥0.40). Correlations for domains with similar constructs were stronger than those measuring varied constructs. Structural equation modelling recommended approximately moderate relationships among the SF-36 and WHOQoL-BREF domains. CONCLUSION: Our study suggests that SF-36 and WHOQoL-BREF are reliable instruments for clinical and research uses, respectably. However, results of the goodness of fit showed that the WHOQoL-BREF was fitted well. Also, the WHOQoL-BREF can be considered more suitable for the study population.

Spatiality in small area estimation: A new structure with a simulation study.

In numerous practical applications, data from neighbouring small areas present spatial correlation. More recently, an extension of the Fay-Herriot model through the Simultaneously Auto- Rregressive (SAR) process has been considered. The Conditional Auto-Regressive (CAR) structure is also a popular choice. The reasons of using these structures are theoretical properties, computational advantages and relative ease of interpretation. However, the assumption of the non-singularity of matrix (Im-ρW) is a problem. We introduce here a novel structure of the covariance matrix when approaching spatiality in small area estimation (SAE) comparing that with the commonly used SAR process. As an example, we present synthetic data on grape production with spatial correlation for 274 municipalities in the region of Tuscany as base data simulating data at each area and comparing the results. The SAR process had the smallest Root Average Mean Square Error (RAMSE) for all conditions. The RAMSE also generally decreased with increasing sample size. In addition, the RAMSE valuess did not show a specific behaviour but only spatially correlation coefficient changes led to a stronger decrease of RAMSE values than the SAR model when our new structure was applied. The new approach presented here is more flexible than the SAR process without severe increasing RAMSE values.

Customized patient clothing and patient satisfaction.

PURPOSE: To respect the patients' physical privacy, they should be provided with proper clothing that prevents the exposure of unnecessary parts of the body. The purpose of this paper is to evaluate patient satisfaction upon wearing customized, high-coverage, procedure-specific dresses. DESIGN/METHODOLOGY/APPROACH: New designs of clothing adapted for different kinds of procedures, and offering a good coverage of the body and easy access to the required parts were compared with regular patient clothing. Patients from six different wards of a university hospital filled out a questionnaire inquiring about general and demographic variables, and patient satisfaction was evaluated based on six main features of the clothing design. p<0.005 was considered as the level of statistical significance. FINDINGS: Overall, 256 patients were entered into the regular-design and new-design groups (n=128 in each). In Group 1 (regular design), the rate of dissatisfaction was about 98, 84, 84, 78, 77 and 38 percent for ease of wearing, comfort, design, material, coverage level and size, respectively. In Group 2 (new design), the highest satisfaction rates were associated with ease of wearing, size, coverage level, material, design and comfort as 93.7, 91.4, 89.9, 87.1, 86, and 80.5 percent, respectively. ORIGINALITY/VALUE: The present study is the first to investigate customized patient clothing and demonstrated that these clothes can improve the patients' satisfaction in terms of coverage, comfort, design and size.

Reliability and validity of the Persian version of patient assessment of constipation- quality of life (PAC-QOL) questionnaire.

AIM: The present study aimed to assess the reliability and validity of Persian version of patient assessment of constipation: quality of life (PAC-QOL) questionnaire in Iranian patients. BACKGROUND: Chronic constipation has significant effects on daily living, wellbeing and individuals' quality of life (QOL). Validated tools can help us to assessing QOL in affected ones and facilitating clinical management of them. METHODS: The English version of Patient Assessment of Constipation: Quality of Life (PAC-QOL) was translated into the Persian language and was confirmed by back-translation. One hundred and forty patients with functional constipation, according Rome III criteria, completed the questionnaires .The questionnaires were analyzed using Cronbach's Alpha internal consistency score to determine the reliability. Twenty medical experts were then asked to evaluate the PAC-QOL and the results were used to calculate the Content Validity Ratio (CVR) and Content Validity Index (CVI). RESULTS: Due to obtained value for Cronbach`s α (0.975) and also for the subscale of physical discomfort (0.930), psychosocial discomfort (0.975) and worries and concerns (0.915), the internal consistency is established. According to medical experts' opinions, the value of CVR ranged from 0.5 to 0.8 and the value of CVI was 0.81. CONCLUSION: The Persian version of PAC-QOL questionnaire is shown to have acceptable reliability and validity to be used for psychometric evaluation in Iranian patients complaining of functional constipation.

Frequency of Celiac Disease in Patients With Increased Intestinal Gas (Flatulence).

Excessive flatulence which impairs social performance in patients is one of the common reasons for referrals to gastroenterology clinics. Celiac Disease is a rare but important cause of increased intestinal gas (bloating) and if not diagnosed, patients face complications such as malabsorption, anemia, osteoporosis and even intestinal lymphoma. This study aimed to determine the frequency of Celiac Disease in patients with excessive flatulence.One hundred and fifty patients with a chief complaint of experiencing flatulence more than 15 times a day and lasting for three months were referred to the gastroenterology clinic of Rasoul-e-Akram Teaching Hospital. Serological tests for Celiac Disease, Anti TTG Ab (IgA-IgG) were requested and the patients with positive tests underwent upper GI endoscopy. Biopsies of the second part of the duodenum were then sent to the laboratory.From one hundred and thirty patients who completed the study, 92 (70.7%) were female. Mean age of the patients was 32 ± 13 years. Anti TTG Ab was found in 5 patients (3.85%). Only 2 patients (1.5%) had a documented positive pathology for Celiac Disease.According to the results of this study and other studies, we conclude that Celiac Disease is an uncommon etiology for excessive flatulence but it is of importance to investigate it in excessive flatulence patients.