فهرست مطالب e. hajizadeh

Today, cancer is one of the deadliest causes in the world and one of the top three causes of death in developed countries and Iran. Due to the importance of this issue, the present study aimed to investigate the incidence of cancer registration in Razavi Khorasan province between 2012-2015 using multilevel modeling.

The present study is a longitudinal study. The data used in this study were extracted from the cancer registration system of Razavi Khorasan province between 2012-2015. In this study, we investigated the incidence of brain and central, bladder, lung bronchus and trachea, breast, colon and anal canal, leukemia and blood, oesophagus, ovary, skin, stomach, thyroid gland nervous system cancers. MlwiN (version 2.2) and GIS software (version 10) were used to analyzed data and mapping the geographic map respectively.

Among the 11 cancers studied in this study were breast (37.42), skin (11.09), colon (8.54), stomach (8.33), esophagus (7.52), thyroid (5.30), leukemia and blood (4.35), lung bronchus (4.07), ovarian (3.65), bladder (2.51) and central and central nervous system (1.92) had the highest to lowest annual mean relative incidence of cancer per 100,000.

Given the high prevalence of the three types of breast, skin and colon cancers in Razavi Khorasan province, it is recommended that appropriate measures be taken to prevent, screen and treat these cancers.

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 purpose of this study was to predict the mortality rate of colorectal cancer in Iranian patients and determine the effective factors  on the mortality of patients with colorectal cancer using random forest and logistic regression methods.   Data from 304 patients with colorectal cancer registry from the Gastroenterology and Liver Research Center of Shahid Beheshti University of Medical Sciences during the years 2009 to 2014 were used as a retrospective study. Data analysis was performed using random forest and logistic regression methods. To analyze the data, R software version 3.4.3 was considered.   Ten important variables related to colorectal cancer deaths were selected by random forest method. Several criteria such as the area under the characteristic curve (AUC) were used to compare the random forest method with logistic regression. According to both criteria, five important variables ranked by random forest were Cancer stage, age of diagnosis, patient's age, HLA, and degree of differentiation (tumor differentiation). In terms of different criteria, the random forest method had better performance than logistic regression (Area under the ROC curve for random forest and logistic regression methods was: 98%; 80% respectively).   Variables such as Cancer stage, age of diagnosis, patient's age, HLA, and degree of differentiation are considered as the most important factors affecting mortality in colorectal cancer, that the patients' longevity can be increased with the early diagnosis of cancer and screening programs.

  Academic failure is of paramount importance for medical students because it might lead to a decline in scientific level of the community of physicians in the future. This study was conducted to investigate the predictors of academic failure in medical students of Lorestan University of Medical Sciences using classification tree.

In this cohort study, academic records of all medical students of Lorestan University of Medical Sciences during the academic years of 1999-2008 were selected by census and were followed up until September 2016. Academic failure was defined as having at least one of the components of appropriate grade point average, prolonged graduation, academic probation, dropout, expulsion, and any failure in ccomprehensive exams and the CART classification tree was adopted using the SPSS 22 software to predict it.

The cumulative incidence of academic failure was 26.4% and the most prevalent components were prolonged graduation (21.7%) and academic probation (15.0%). The probability of academic failure was 0.449 in subjects taking guest courses, 0.220 in subjects with no history of guest courses admitted to courses with less than 40 students and admission quotas of zone 1 or 3, and 0.456 in subjects with no history of guest courses admitted to courses with more than 40 students and males.

With respect to identifying the predictors of academic failure, it is suggested that these students be referred to consulting centers of the university or educational supervisors’ moreover, the regulations of taking guest courses in other universities should be revised.

Assessment tools and questi-onnaires that are used in research to measure the achievement of research ob-jecttives must be standardized themselves to ensure the results. The aim of this study was to design the validity and reliability of osteoporosis prevention instrument based on health belief model in women.

This cross-sectional study was carried out on 400 women، aged 30 to 50 years old، in Fasa city. After revi-ewing the related literature، a suitable instr-ument was designed and its content validity ratio، content validity index، face validity، and exploratory factor analysis were mea-sured. For measuring the reliability of the scales، three methods، including test-retest، internal consistency، and agreement were used. Data analysis was done using SPSS software.

Reliability of 42 items with imp-act score of 0. 15 and content validity index of 0. 79 were evaluated based on explo-ratory factor analysis and classified into se-ven categories. The overall reliability، me-asured through Cronbach alpha، was 0. 87. Reliabilities of knowledge questionnaire، perceived susceptibility، perceived severity، perceived benefits، perceived barriers، mot-ivation، self-efficacy، and cue to action were 0. 86، 0. 71، 0. 82، 0. 79، 0. 82، 0. 77، 0. 79، and 0. 77، respectively. Discussion &

This study prov-ided good evidence on the strength of factor structure and reliability of Health Belief Model structures for prevention of oste-oporosis women، according to the study of psychometrics process.

Cox regression model is one of the statistical methods in survival analysis. The use of smoothing techniques in Cox model makes the more accurate estimates for the parameters. Fractional polynomial is one of these techniques in Cox model. The aim of this study was to assess the effects of prognostic factors on survival of patients with gastric cancer using the fractional polynomial in Cox model and Cox proportional hazards.

Information of total of 216 patients with gastric cancer who underwent surgery in the gastroenterology ward of Taleghani Hospital in Tehran between 2003 and 2008 were included in this retrospective study. In this research، fractional polynomial in Cox model and Cox proportional hazards model were utilized for determining the effects of prognostic factors on patients’ survival time with gastric cancer. The SPSS version 18. 0 and R version 2. 14. 1 were used for data analysis. These models were compared with Akaike information criterion.

The analysis of Cox proportional hazards and fractional polynomial models resulted in age at diagnosis and tumor size as prognostic factors on survival time of patients with gastric cancer independently (P<0. 05). Also، Akaike information criterion was equal in both models.

In the present study، the Cox proportional hazards and fractional polynomial models led to similar results with equal Akaike information criterions. Using of smoothing methods helped us eliminate non-linear effects but it seemed more appropriate to use Cox proportional hazards model in medical data because of its’ ease of interpretation and capability of modeling in both continuous and discrete covariates.

The use of intra-vein cutters is one of the most prevalent and painful procedures، and children especially young children usually call it the most stressful aspect of their disease، hospitalization، and even their outpatient visit. The present research investigates the influence of familiarization play on the pain severity in the case of injection procedures on pre school age children.

The present study is a clinical experiment. The research sample consists of 60 Thalassemic children of 3-7 years old، in Thalassemia sections in Gilan. The participants were randomly divided into two groups. In the experimental group، a familiarization play was carried out for 10-15 minutes prior to the injection procedure. The instruments used in the research include: demographic characteristics، the Questionnaire of child clinical fear and the self report instrument of Chip Pooker Pain، The analysis of the data was carried out by using SPSS.

The data indicated that after the treatment، there was a significant difference between the experimental group and the control group in terms of the average scores of pain. It showed a significant decline in the familiarization play group (P< 0. 05).

According to the research results، the treatments of familiarization play is influential on the pain decrease resulted from the injection procedures in children Therefore it is suggested that child nurses use the methods of familiarization play in order to comfort the children with acute and chronic diseases who are frequently under treatment measures.

During Thalassemia، children should be under frequent blood injections to maintain their lives. The use of intra-vein cutters is one of the most prevalent and painful procedures، and children specially young children usually call it the most stressful aspect of their disease، hospitalization and even their outpatient visit. The present research is an investigation of the influence of familiarization play on the anxiety in the case of injection procedures for children before school age.

The present study is a clinical experiment. The research sample consists of 60 Thalassemia children of 3-7 years old، possessing files in Thalassemia sections in Gilan Province. The participants were randomly divided into two groups (experimental group and one control group). In the experimental group، a familiarization play was carried out for 10-15 minutes prior to the injection procedure. The instruments used in the research include: Demographic Information Questionnaire، the Scale of facial self report of anxiety، and the Questionnaire of child clinical fear self report. The analysis of the data was carried out through SPSS and the statistic test: chi-square، t-test، Mann-whiney and Wilcoxon sign.

The data indicated that there was not a significant difference between the average scores of anxiety in the two groups prior to the treatment (P>0. 05). However، after the treatment، the statistic test Mann-whiney and Wilcoxon sign showed a significant difference between the experimental group and the control group in term of the average scores anxiety (P<0. 05).

According to the research results، the treatment of familiarization play is influential on anxiety decrease resulted from the injection procedures in children. Therefore it is suggested that child nurses use the method of familiarization play in order to comfort of children with acute and chronic diseases who are frequently under treatment measures. Key words: Anxiety، child before school age، Thalassemia، nurse، familiarization play

Antenatal maternal anxiety is common during pregnancy and may have side effects on mother and neonate. The aim of this study was to evaluate the relationship between maternal anxiety and neonatal outcomes in nulliparous women.

In this analytical prospective study 156 pregnant women were studied in Qom health care centers. Anxiety was assessed using a self-administered Spielberger's state-trait anxiety questionnaire (STAI) at 28th and 38th weeks of pregnancy. Then time of delivery, height and head circumference of neonates, fetal growth restriction, respiratory distress, low birth weight and Apgar score of neonates were obtained from the women’s clinical records. The data were analyzed using logistic regression test, Chi-square, and Fisher exact.

The findings indicate that there is no significant relationship between the rate of fetal growth restriction, preterm labor and low Apgar score at the 28th and 38th weeks of pregnancy in anxious and non anxious women (P>0.05).

The results of this study revealed that anxiety does not directly affect the health of a baby. Finally, anxiety during pregnancy is an independent risk factor that may affect pregnancy outcomes.

Clinically Chronic Allograft Dysfunction (CAD) is characterized by a progressive decline in Glomerular Filtration Rate (GFR) over time, the pattern of disease progression determined by the five-stage model. In this paper, we used Erlang and Hypo-exponential distributions as Phase- Type distributions to describe hazard of kidney failure at over time in RTR with CAD.

In a single-center retrospective study, 214 patients with RTR with CAD were investigated at the Emam Hospital of Urmia University of Medical Sciences from 1997 to 2005. Kidney function at each visit assessed with GFR and categorized based on NKF and KCOQI staging system.

The estimated hazard rates of disease progression from stage 1 to 2, 0.0378; from stage 2 to 3, 0.04; from stage 3 to 4, 0.0458; and from stage 4 to 5; 0.0541 were respectively based on each expected month. This estimates yield a mean waiting time of disease progression from stage 1 to Kidney failure or dialysis 91.63 month. The 18th, 58th, 118th and 155th months of death-censored graft survival were 0.99, 0.75, 0.25 and 0.10 respectively.

The findings of this study are compatible with hyperfiltration theory in chronic kidney disease and give us more detailed information about the daynamic process of disease which would help to manage it effictevliy.

Nursing records are considered as an indicator of care and its quality; therefore, any flaw in them can represent inadequacy of care. Peer review is an approach to authority submission by managers for nursing quality assurance.

This quasi-experimental study was conducted to determine the effects of peer review process implementation on the quality of nursing records in critical cardiac wards (CCU and PCCU) at governmental hospitals of Arak in 2007.

4 wards (CCU and PCCU) at 2 hospitals in Arak were selected. 2 wards with more nursing staff (25 nurses) and the other 2 with less staff (19 nurses) were chosen as case and control groups respectively. Checklists for assessing the quality of nursing records were used for data collection. 35 checklists were completed by a colleague as a pretest. Raters had been instructed regarding the assessment 1 month before the intervention. The peer review process was then performed by the raters 1 month with direct and 1 month without direct supervision of researchers. The checklists were completed again for both groups as a posttest.

No significant difference was found between the groups in terms of demographic characteristics (age, education, financial status,…). There was no relationship between these characteristics and the quality of records. However, a significant difference was found between the groups regarding the quality of records before and after the intervention (P