علی اکبر راسخی

Today, according to the advancements in cancer treatment, a fraction of patients never experience an adverse event, such as death, even when the duration of the disease is prolonged. Cure models are used in the analysis of these types of diseases. In this study, we examined the survival of patients, the cure probability, and the affecting factors among breast cancer patients.

We analyzed the data of 1,247 breast cancer patients who referred to Motamed Jihad University Research Institute in Tehran between 1995 and 2013 and followed them up until 2018. Data analysis was done using R version 4.3.0 software to check the survival time of uncured patients and the cure rate and to identify the effective factors with the Bayesian estimation method by fitting the semi-nonparametric smooth mixture cure model.

The results of this study showed that out of 1,247 patients with breast cancer, 82.8% of the patients were censored, and 17.2% of the patients died. The cure rate was 58%, according to the Kaplan-Meier curve. Examining the factors affecting the death of patients showed that the patient's high weight, more advanced stages of the disease, involvement of lymph nodes, and breast-conserving surgery were effective on the time to death and short-term survival.

Based on the results of this, there are several crucial prognostic factors associated with breast cancer that play a significant role in identifying high-risk patients and choosing the type of treatment in the short term.

cardiovascular diseases have a high prevalence in the world and are considered one of the main causes of death. To reduce the prevalence and mortality of heart diseases, pharmacological and non-pharmacological measures are considered. Medicine is the main link in the treatment chain and its correct use is important. In the field of non-pharmacological measures, strategies to deal with negative emotions such as stress, anxiety, and depression are considered because they can cause and aggravate heart diseases. This study investigated the relationship between the management of the principled use of drugs with stress, anxiety, and depression in patients with coronary artery disorders.

This research is a correlational descriptive study in which 115 patients with coronary artery disease or class one and two heart failure with medical records the only hospital in Gonabad city was selected and examined by a simple random method based on the inclusion criteria. The DASS-21 questionnaire and the researcher-made questionnaire for the management of the basic use of drugs along with demographic information were provided to the samples. After determining normality using  Spearman's test and regression analysis and using descriptive statistics methods (prevalence, percentage, mean, standard deviation) and using SPSS version 25 software

Based on the results of Spearman's test, there was a significant and inverse relationship between the management of basic medication use and DASS (p<0.05, r=-0.28). Also, there was a significant and inverse relationship between the dimensions of DASS including anxiety (r=-0.24), stress (r=-0.27), and depression (r=-0.22) with the management of the principal use of drugs

In this study, the relationship between stress, anxiety, and depression with the management of basic medication use in patients with coronary artery disorders was investigated, and there was a significant and inverse relationship between the management of basic medication use and stress, anxiety, and depression. Therefore, it can be said that the higher the level of stress, anxiety, and depression, the more people will be in a weaker position in terms of managing the basic use of drugs.

Breast cancer is the most common cancer among women. Today, with advancements in medical sciences, increasing the cure probability of patients as well as increasing survival time is an important goal of cancer treatment. Therefore, in this study, in addition to examining patients’ survival, we investigated the cure probability of breast cancer patients and its prognostic factors using the semiparametric mixture cure model.

 This is a retrospective cohort study of 1310 breast cancer patients admitted to Motamed Cancer Institute from 1995 to 2013 and followed up until 2018. The Kaplan-Meier curve and a semiparametric mixture cure model were fitted to data. In this model, patients were divided into two categories of cured and uncured, then the cure rate and the survival rate of uncured patients were calculated, and related factors were identified.

 Of the 1310 women with breast cancer in the study, 235 (18.1%) cases died and others were censored. Based on the Kaplan-Meier curve, the cure rate was 68%, and the last death case was observed about 12 years after diagnosis. Obesity, lymph node involvement, and mastectomy were identified as risk factors for patients' long-term survival, while larger tumor size, more advanced stage of the disease, and lack of chemotherapy were risk factors for short-term survival.

 These findings indicate that many prognostic factors for breast cancer are not only important when choosing a treatment strategy in the short term, but they also play an important role in the long-term to identifying high-risk patients and those who still need further follow-up.

Objective (s):

 The association between self-esteem and the process of mental development of individuals and mental health is well established. In adolescence, the role of parents and their skills in communicating is very sensitive and vital. The purpose of this study was to assess the effect of parentschr('39') communication skills training on the self-esteem of adolescent female students.

This was a quasi-experimental study that conducted in one of the state high schools in Damavand, Iran in 2019. The sample consisted of 77 adolescent girls and their parents who were assigned to two groups: intervention and control. Parents in the intervention group received 16 training sessions in a group pf 10 participants. The control group received nothing. In both groups students completed a self-esteem questionnaire (Cooper-Smith questionnaire) at two points in time: before intervention and three months after the intervention. The data were analyzed by Wilcoxon, Mann-Whitney and analysis of covariance using SPSS22 software.

Both groups were similar in most characteristics and at baseline self-esteem score did not differ significantly between two groups (p=0.49). However, after the intervention, there was a significant difference between the experimental and control groups according to analysis of covariance (p=0.001).

Conclusion :

The findings suggest parentschr('39') communication skills training could be effective in improving adolescents’ self-esteem.

Therapies for many of diseases, especially cancer, have been improved significantly in the recent years, resulting in an increase in the number of patients who do not experience mortality. Therefore, the application of cure models is more suitable for survival analysis in this population than the usual survival models are. The aim of this study was to estimate the recurrence-free cure rate of breast cancer using the Poisson Beta Weibull (PBW) cure model and to determine the correlating factors.

The data for this study came from a cohort of 271 breast cancer patients who had visited Motamed Cancer Institute, Tehran, between 1997 and 2006 and were followed up from 2013 to 2017. In this study, the time interval between diagnosis and recurrence of the disease was calculated, and the effect of factors was estimated using a Cox survival model as the most common method of survival analysis. Then, by calculating the cure rate from recurrence, the effect of factors on patients’ survival and cure was analyzed using Weibull and PBWcure models. Data were analyzed using R, v 3.4.1, at a significance level of 5%.

The results showed that 17 (6.3%) of patients experienced relapse after treatment. One-, 3-, and 5-year survival rates for the patients were 0.97, 0.96, and 0.93, respectively. The results of this study showed that PBW Model has a better fit to data with the smallest AIC. Based on this model, estrogen receptor positivity was a significant factor affecting patients' cure (HR = 0.27) and the cure fraction was estimated to be 92%.

Estrogen receptor positivity is the most important factor affecting patients’ cure. The Poisson Beta Weibull cure model has a better fit to data. Since the model analyzes factors affecting both survival and cure, using this model is recommended in the analysis of the events with low incidence.

Toxoplasma gondii (T. gondii) is a compulsive intracellular parasite of the Apicomplexa phylum that contaminates a wide range of vertebrates including humans, and it causes disease. The current study aimed to evaluate the anti-Toxoplasma gondii effects of Artemisia aucheri.

Tachyzoite assay was performed to evaluate the death rate of the parasite. Flow cytometry technique has been used in order to determine the possible induction of apoptosis in T. gondii tachyzoites. Furthermore, 50% inhibitory concentration (IC50) was obtained for macrophages by MTT assay.

The IC50 values of autumn and spring extracts of A. aucheri was estimated about 136 μg/ml and 119 μg/ml, respectively, in treated T. gondii tachyzoites. After 24 hours of macrophage incubation, the highest rate of cytotoxicity was observed in high concentrations of spring and autumn A. aucheri extracts. Based on the flow cytometry results the rates of normal, necrotic, and apoptotic cells treated with autumn extract were 93.1%, 2.45%, and 4.49%, respectively, and when with spring extract was treated, the rates were 60.4%, 3.99%, and 35.54%, respectively.
Discussion and

We concluded that the autumn and spring extracts of A. aucheri has lethal effect on T. gondii tachyzoites and also induces the apoptosis in parasites.

Nowadays, cancer is one of the most important medical problems. Breast cancer is also considered as the most common cancer of women: its prevalence has risen throughout the world in recent centuries and people can experience recurrent events that sometimes accompany with a terminal event. In the present study, using a frailty model we tried to model recurrent event in the precence of terminal event (death) in breast cancer patients.

In the current retrospective survival study, 342 patients with breast cancer registered in the cancer research center of Shohada-e-Tajrish Hospital were examined. The Liu model was used to joint modeling of recurrent events and terminal events, in which a shared frailty with Gamma distribution was used. Estimation of the parameters was done by the penelized maximum likelihood method and the frailtypack package in the R software version 3.4.1 was used to implement the model and analyzed the data. Significance level was set at 0.05.

In our cohort study, 342 women with breast cancer were studied. A univariate and multivariate analyses was performed for these patients. Of these, 78 cases (25.4%) had recurrence events, and 225 patients (74.6%) were censored. The obtained results of joint frailty model indicated that the relative risk of relapse in patients with first-degree familial history was 36% higher than that of other people (P <0.05). Relative risk of relapse in patients with stage 3 disease was 19% more than other stages and also the relative risk of relapse in patients with chemotherapy were 2.5 times higher than those without chemotherapy.

It seems that by investigating the effects of factors affecting the occurrence of recurring events with death with regard to unknown factors, such as modeling, we can simultaneously simulate the probabilistic nature of the disease and provide more accurate information to the researchers.

Breast cancer is one of the most common recurrence cancers among women. There are several factors that can affect multiple recurrence of this disease. On the other hand, simultaneous examination of the types of relapses will make the results more accurate. The purpose of this study was to use a joint frailty model to model multiple recurrences of breast cancer patients.

In this retrospective survival study,342 breast cancer patients whose records were registered at the Shohada Tajrish Hospital Cancer Research Center (Tehran, Iran) were investigated in 2005-2015. Patients were monitored for at least 6 months after diagnosis and their last condition was recorded in this study, the joint frailty survival model was used and data analysis was done in R software version 3.4.1.

The 3-year and 5-year survival rates were 0.79 and 0.68 respectively. According to the results of the fitted joint frailty model, it can be said that the risk of multiple recurrence is increased for patients with tumor grade greater than I. Also, tumor size (>20 mm) has a significant effect on the risk of recurrence and the risk of local and metastatic recurrence is more for HER2+ patients.

According to the results of this study, the relationship between metastasis and local relapses was high in breast cancer patients, which has great importance in the process of recognizing and treating of this disease. Although in this study, in a large sample of patients, there was a positive correlation between multiple recurrences, but these results should be considered with caution with small number of recurrences.

In many medical situations, people can experience recurrent events with a terminal event. If the terminal event is considered a censor in this type of data, the assumption of independence in the analysis of survival data may be violated. This study was conducted to investigate joint modeling of frequent events and a final event (death) in breast cancer patients using a frailty model.

In this retrospective cohort study, 443 patients with breast cancer registered at the Hospital of Shohadaye Tajrish Cancer Research Center were studied. The model of Liu (2004) was applied for joint modeling of recurrent events and a terminal event in which a shared frailty with gamma-distribution was used. Data modeling and data analysis were done using the R software.

Four hundred and forty three women with breast cancer were studied. Univariate and multivariate analysis were performed in these patients. Of these, 338 cases (76.3%) had recurrence events, and 105 (23.7%) were censored. The obtained results of joint frailty model indicated that the relative risk of relapse in patients with a positive first-degree family history was 36% higher than that of other people (P<0.05). The relative risk of relapse in patients with stage 3 disease was 19% more than other stages and also the relative risk of relapse in patients with chemotherapy was 2.5 times higher than those without chemotherapy.

In this study, the presented model, in addition to simultaneous modeling capability of the event, could help prevent a higher prevalence of the terminal event (death) and thus reduce the adverse effects of reversible diseases.

The importance of the infant’s proper nutrition and the vital role of breastfeeding in the survival, growth, and development of the child are well known. Breastfeeding helps protect infants against some of the main causes of childhood mortality. This study aims to investigate the factors affecting breastfeeding duration in primiparous women referring to Tehran health centers. In this analytical study, the population consisted of primiparous women of reproductive age (20-41 years) who referred to Tehran health centers in 2015-2016 having a child aged 2-5 years. Data were collected using the Health Literacy for Iranian Adults and interviews with mothers. Data analysis was performed using Poisson regression method in R software. In the present study, the minimum breastfeeding duration and maximum were one and 24 months and the median duration of breastfeeding was 20 months. Also, exclusive breastfeeding was reported at 50.5%. The variables of health literacy score (P<0.001), a method of delivery (P=0.03), The first lactation time at the level first time breastfeeding one hour after birth and at the first-time breastfeeding more than one hour after birth (P<0.001) had a significant relationship with breastfeeding duration.ConclusionThe health literacy score, method of delivery, the first-time breastfeeding had a significant relationship with breastfeeding duration. Therefore, health care planners have taken steps to improve maternal health literacy, as well as knowledge of the natural delivery and breastfeeding method in order to guaranty the infants’ health in the community.

Exclusive breastfeeding (EBF) is infant’s breast milk consumption without supplementation of any kind of food or drink. Nowadays, EBF has been considered as a key strategy for ensuring the growth and survival of the child. This study aims to investigate the factors affecting exclusive breastfeeding in primiparous women referring to Tehran health centers. In this analytical study, the sample consists of primiparous women in reproductive age who referred to Tehran health centers in 2015-2016 having a child aged 2-5 years. Health literacy was measured by Health Literacy for Iranian Adults (HELIA) questionnaire which measures health literacy with 25 items graded on a 5-point scale. The data were analyzed by binary Bayesian regression model and using OpenBUGS software. EBF was reported 50.5%. The variables of maternal age (OR=0.87, CI: (0.80, 0.97)) and health literacy score (OR=1.11, CI: (1.16, 2.01)) had significant relationship with EBF. The method of delivery had no significant effect. Results showed that health literacy score played an important role in exclusive breastfeeding besides maternal age. Therefore, considering the importance of the effect of health literacy on breastfeeding, it is suggested that mothers have the ability to obtain a high score of health literacy before pregnancy time.

‎WinBUGS is one of the usual softwares in computational Bayesian statistics‎, ‎which is used to fit Baysian models easily‎. ‎Although this software has usual mathematical functions and statistical distributions as built in functions‎, ‎sometimes it is necessary to include other functions and distributions in computations which is done by some tricks and indirectly‎. ‎By using WinBUGS development interface (known as WBDev)‎, ‎new mathematical functions and statistical distributions can be added in the software‎. ‎This method facilitates writing codes of statistical models‎, ‎increases speed of computations and make computations more efficient‎. ‎In this paper‎, ‎the stages of including new mathematical functions and statistical distributions in the WinBUGS are illustrated by some examples‎.

  Therapies for many of diseases especially cancers have been improved significantly in the recent year, so there have been an increased number of patients who do not experience mortality. In analysis of these disease, cured models is used instead of usual survival models. Weibull model and its generalized version beta Weibull Poisson (BWP), are flexible models in cure models and are used in this study to analyze braset cancer patients data. The data of this cohort study are from patients with breast cancer, were gathered during 1997 to 2006 to the Motamed Cancer Institute in Tehran, and were followed up from 2013 to 2017. A random sample of size 270 patients was selected and individual characteristics evaluated. The data were analyzed using Stata 12 and R3.4.1 software and the significance level set at 0.05. The results showed that 43 (15.9%) of patients deaths after treatment. One, three and five year Cure of the patients was 0.99, 0.87 and 0.83 respectively. The results of this study showed that PBW Non-Mixture Cure Model (AIC=427) has better fit than weibull (AIC=593). Based on this model, variables of tumor size greater than 5,(P<0.001) and, tumor grade 3,(P<0.001) are factors affecting of patients cured; and the cure fraction was estimated to be 80%. By study the effect of factors affecting the occurrence of death, considering the unknown number of causes and using BWP models, the cancer trend can analyzed better and more accurate information can be available to researchers.

Breast cancer is one of the most common recurrence cancers among women. There are several factors that can affect the multiple recurrence of this disease, which have been studied and recognized in various studies, however, with the fact that these factors are known, cannot always accurately predict the incidence of metastasis. On the other hand, simultaneous examination of the types of relapses will make the results more accurate. One of the types of models used to analyze recurrent events with heterogeneity among patients is a frailty model. The purpose of this study was to use a joint frailty model to model multiple recurrences in breast cancer patients data. In this retrospective study, 342 breast cancer patients whose records were registered at the Shohada Tajrish Hospital Cancer Research Center were investigated. Patients were monitored for at least 6 months after diagnosis, and their last condition was recorded. For data analysis, the joint frailty survival model was used. Data modeling and data analysis were done in R software. The three-year and five-year survival rates for patients were respectively 0.79 and 0.68 respectively. According to the results of the fitted joint frailty model, it can be said that the risk of multiple recurrence (local and metastasis) is increased for patients with tumor grade greater than I. We also found that if we did not consider the relationship between multiple recurrence in patients with breast cancer, we would lose significant correlation. Considering the significant variance of the frailty component of the metastasis event, it can be concluded that patients with the same predictor variables also have a different metastasis risk and, on the other hand, given the low frequency of types of recurrences in this study, the results should be considered with caution.

 The World Health Organization (WHO) has approved exclusive breast-feeding during the first six months of childhood. The aim of this study was to determine the relationship between exclusive breast-feeding, health literacy and other affective factors in primiparous women using logistic regression model.  This study was an analytic study. The population of this study consisted of primiparous women on reproductive age visiting health centers in Tehran, with a child aged two years to five. Data were collected by questionnaire and interview with mothers and analyzed using logistic regression model.  Exclusive breast-feeding was reported in 50.5% of mothers. There was a statistically significant relationship between exclusive breastfeeding and variables health literacy level in adequate level (p<0.001) and not much enough level (p<0.05), mother’s age (p<0.001), the first time of lactation in level of greater than one hour and a level after one hour (p<0.001), the delivery method (p <0.05), and job (p <0.05). The adequacy of the model was confirmed by the Hosmer-Lemeshow test.  The level of health literacy and the variables of the first time lactation, maternal age, delivery method and occupation were affected by exclusive breast-feeding. Therefore, considering the above factors, especially increasing the level of mothers' health literacy through the organization of workshops can be effective.

Endometriosis is one of the prevalent chronic diseases in women that causes infertility and other problems. Since severity of this disease is expressed in ordinal scale, the aim of this study is to analyze risk factors and progress of the disease by ordinal logistic regression and cumulative logit model. In this cross-sectional study, we studied infertile women that referred to two infertility clinics. Based on laparoscopy results, the severity of endometriosis was divided into three levels, control (without disease), mild disease (stages I and II of the disease) and severe disease (stages III and IV of the disease), and cumulative logit model was used to study risk factors related to endometriosis. Proportional odds for each significant variable, test of parallel lines and Area Under Curve (AUC) were found. Significance level was set at 0.05 and the analysis was done by R 3.4.0 Cumulative logit model showed that family history, Body Mass Index (BMI), age, dyspareunia, contraceptive use, duration of menstrual pattern, amount of menstrual bleeding, and pelvic pain were significant. Among these factors, the effects of family history, pelvic pain, dyspareunia and amount of menstrual bleeding were noticeable. The AUC was 0.79 which showed predictive power of the model. Any type of endometriosis could be predicted using ordinal regression model better than logistic regression. This model has more application and better interpretation and besides incidenc, shows progress of the diseases.

One of the main concerns of heart specialists is the occurrence of restenosis after coronary angioplasty which can lead to coronary artery bypass graft, myocardial infarction, and death. The present study was conducted to investigate the factors affecting the frequency of restenosis during four years in patients of Zanjan.
In the present retrospective cohort study, all the patients who underwent angioplasty in Ayatollah Musavi Hospital of Zanjan from April of 2009 to June of 2011 were examined in terms of the frequency of restenosis. According to the patients’ medical records, all the demographic and clinical data of the patients were collected. Since the dependent variable was count in nature and the data were over-dispersed, negative binomial regression was used for modeling.
The incidence of at least one restenosis during four years after angioplasty was calculated to be 43%. According to the negative binomial regression model, the ratio of restenosis in patients suffering from diabetes, unstable angina, chronic kidney disease, and myocardial infarction was 32%, 44%, 66%, and 30% more than other patients, respectively (P In the present study, the effective factors of restenosis were recognized as diabetes, unstable angina, chronic kidney disease, and history of myocardial infarction; hence, assessment and periodic follow-up of these patients are strongly recommended.

The incidence of restenosis after coronary angioplasty is one of the main concerns of heart specialists which can lead to heart bypass surgery, myocardial infarction, and death. The aim of this study was to determine the clinical factors related to the prevalence of restenosis in patients undergone angioplasty using logistic regression in patients of Zanjan city. In the present case-series study, all the patients who referred to Ayatollah Musavi hospital of Zanjan city from April 2009 till June of 2011 for angioplasty were followed-up for the occurrence of restenosis. Based on the patients’ medical records, all of the demographic and clinical data were gathered by “Data Gathering form of Patients Undergone Angioplasty”. Content validity was confirmed and its reliability was approved by Kappa test. Data was analyzed by SPSS/ 21. The prevalence of restenosis after angioplasty was estimated around 43%. According to the logistic regression model, the odds ratio of restenosis in smoking patients was 87%, in patients with unstable angina was 71% and in those who had a history of myocardial infraction was 76% more than other patients (P<0.05). In the present study, the effective factors of restenosis were reported as smoking, suffering from unstable angina and history of myocardial infraction. Therefore, in order to prevent the occurrence of these risk factors, it is crucial to perform regular follow-ups of patients at risk.

Hoor-Al azim is one of most important and valuable wetland habitats. Study aimed to identifyanddetermine the abundance of fish in the Hoor-Al Azim marsh during2011-2012. In order to do this research 3 stations were selected and fish sampling was performedusing constant Gill net with 1.7 to 5cm springs. Results showed that there are 15 species of fishof 3 families in the marsh.Cyprinidae family had13 species and the highest frequency87.4. Mugilidae and Siluridae Families withone species were present. Carasobarbusluteus species in Rofaye station and Mesopotamichthys sharpeyi species inTaborstation were dominant and in total Carasobarbusluteus, Mesopotamichthys sharpeyi, Aspiusvarax,Lizaabu and Carassiusauratus species respectivelywith 28.7, 24.6, 15.7, 10.8 and 9.9 percent had the highest frequency during the study. The average water temperature, salinity, and pH in the marsh were 20.72° C, 2.07parts per thousand and 7.28, respectively.In the present study the maximum diversity wasinRofaye station with 1.93 and the minimum diversity was in Tabor station with 1.63.

This paper concerned with the testing of homogeneity of mean vectors against ordered restriction in multivariate normal distribution. Three different cases for covariance matrices are considered. First when covariance matrices are known, second when it is assume that covariance matrices have an unknown scale factor and third when the covariance matrices are completely unknown and equal. In two first cases the critical values of test statistic are computed for bivariate and trivariate normal distribution. The power and p-value of the test statistic are estimated by simulation method. When the covariance matrices are completely unknown and equal some tests are presented which the computation of those probabilities can be used as the upper bonds of p-values.