Missed Nursing Care and Relationship to Burnout and Leave the Profession.

Nurses are at high risk of burnout, desire to leave the profession, and possibly missed nursing care due to the exhausting nature of caring. Missed nursing care may also affect nurses' burnout and desire to leave the profession. Therefore, the objective of this study was to determine the missed nursing care and its relationship with burnout and desire to leave the profession among intensive care unit nurses. The participants of this descriptive analytical study were 249 Iranian nurses working in intensive care units in 2022. The data were collected using a Demographic Information Questionnaire, Kalish's Missed Nursing Care Questionnaire, Maslach Burnout Inventory, and desire to leave the profession questionnaire. The majority of nurses (71%) were females. The generalized linear regression model showed that there was a significant relationship between missed care with gender (B = 5.55, P < .001), marital status (B = -7.37, P = .04), working shift (B = 7.80, P < .001), and employment status (B = -2.87, P = .02). Using structural equation modeling, it was found that the effect of missed care on burnout was significant. Considering the effect of missed care on burnout among nurses working in intensive care units, it seems that creating better working conditions, providing sufficient resources for nurses, supporting them, and changing the factors affecting missed care in order to improve the conditions can reduce the possibility of missing nursing care and, finally, burnout.

Psychosocial Factors and Musculoskeletal Symptoms in Office Workers: Validating the Maastricht Upper Extremity Questionnaire.

Background: Complaints of the arm, neck, and shoulder (CANS) in the workplace are becoming more prevalent among employees. The Maastricht Upper Extremity Questionnaire (MUEQ) validates upper extremity complaints in 7 domains-including workstation, body posture, break time, job control, job demands, work environment, and social support. The aim of the present study was to translate, adapt, and validate the Persian Version of MUEQ among Iranian office workers. Methods: The psychometric evaluation of the Persian version of the MUEQ employed a comprehensive methodological approach comprising face and content validity assessments, confirmatory factor analysis (CFA), and Cronbach's alpha. A panel of 10 experts assessed the face and content validity of the instrument. In the second phase, through a cross-sectional study, the validity and reliability of the questionnaire were measured by CFA and Cronbach's alpha in a sample of 420 people from the target population in Tehran, Iran. Results: The mean age of the participants was 41.40 ± 7.80 years. Examination of upper limb complaints showed that neck pain was the most common complaint among office workers, with a prevalence of 65%. The CFA results confirmed the questionnaire's structure, with 59 items grouped into 7 subscales, and with fit indices-comparative fit index, 0. 87; root mean square error of approximation, 0.08; goodness of fit index, 0.9. The questionnaire demonstrated strong internal consistency, as all items exhibited Cronbach's alpha values of ≥0.9. Conclusion: The psychometric evaluation of the Persian version of the MUEQ showed that it is a valid and reliable tool for evaluating psychosocial factors in the work environment. Identifying psychosocial factors influential in musculoskeletal problems will lead to better planning to change behavior and design constructive interventions to improve behavior. By addressing psychosocial determinants of musculoskeletal issues at both the individual and organizational levels, we can enhance employees' awareness, self-efficacy, and ability to manage their musculoskeletal health and make informed decisions about their well-being.

Development of the short form Iranian women childbirth experience questionnaire: a confirmatory factor analysis approach item reduction.

INTRODUCTION: Considering that childbirth experience has short- and long-term effects on women's lives, it is necessary to examine their delivery experiences. This study aimed to prepare the short form of a 52-item Iranian women's childbirth experience questionnaire with seven factors: professional support, preparation, control, positive perception, baby, family support, and fear. METHODS: This methodological research was conducted on women aged 15 to 49 years (n = 770) with uncomplicated vaginal delivery. The short form of the Iranian women's childbirth experience questionnaire was prepared in four stages. The first stage was exploratory factor analysis, conducted on 250 samples, the second stage was confirmatory factor analysis which was performed on 260 samples, independent of the first stage, to report goodness and fit indices, and the third stage employed items from modification indices, expected parameter change, and standardized residual covariance, leading to the short form of Iranian women childbirth experience questionnaire. Finally, confirmatory factor analysis was run on 260 samples, independent of the previous two stages, to confirm the short form and compare it with the original questionnaire for psychometric analysis. RESULTS: In the exploratory factor analysis stage, nine items with a factor load of less than 0.4 were removed, and the number of domains was reduced to five. The second stage showed that the questionnaire had a goodness of fit index. However, the third stage resulted in removing 11 overlapping items and making a short questionnaire with 33 items. Finally, the confirmatory factor analysis in the last stage showed appropriate goodness of fit for the short form of the Iranian women's childbirth experiences questionnaire (𝛘2/df = 2.352, CFI = 0.881, PCFI = 0.750, RMSEA = 0.072, SRMR = 0.0862). CONCLUSION: The short form of the Iranian women's childbirth experiences questionnaire enjoyed from an appropriate psychometric evaluation. It is recommended when applying the original questionnaire is not feasible due to lack of time.

Estimation of the basic reproduction number (𝑠0) of the COVID-19 epidemic in Iran.

Background: Estimation of the basic reproduction number of an infectious disease is an important issue for controlling the infection. Here, we aimed to estimate the basic reproduction number (𝑅0) of COVID-19 in Iran. Methods: To estimate 𝑅0 in Iran and Tehran, the capital, we used 3 different methods: exponential growth rate, maximum likelihood, and Bayesian time-dependent. Daily number of confirmed cases and serial intervals with a mean of 4.27 days and a standard deviation of 3.44 days with gamma distribution were used. Sensitivity analysis was performed to show the importance of generation time in estimating 𝑅0. Results: The epidemic was in its exponential growth 11 days after the beginning of the epidemic (Feb 19, 2020) with doubling time of 1.74 (CI: 1.58-1.93) days in Iran and 1.83 (CI: 1.39-2.71) in Tehran. Nationwide, the value of 𝑅0 from February 19 to 29 using exponential growth method, maximum likelihood, and Bayesian time-dependent methods was 4.70 (95% CI: 4.23-5.23), 3.90 (95% CI: 3.47- 4.36), and 3.23 (95% CI: 2.94-3.51), respectively. In addition, in Tehran, 𝑅0 was 5.14 (95% CI: 4.15-6.37), 4.20 (95% CI: 3.38-5.14), and 3.94 (95% CI: 3.45-4.40) for exponential growth, maximum likelihood, and Bayesian time-dependent methods, respectively. Bayesian time dependent methods usually provide less biased estimates. The results of sensitivity analyses demonstrated that changes in the mean generation time affect estimates of 𝑅0. Conclusion: The estimate of 𝑅0 for the COVID-19 ranged from 3.94 to 5.14 in Tehran and from 3.23 to 4.70 in nationwide using different methods, which were significantly larger than 1, indicating the potential of COVID-19 to cause an outbreak.

Comparison of methods to Estimate Basic Reproduction Number (R 0) of influenza, Using Canada 2009 and 2017-18 A (H1N1) Data.

BACKGROUND: The basic reproduction number (R 0) has a key role in epidemics and can be utilized for preventing epidemics. In this study, different methods are used for estimating R 0's and their vaccination coverage to find the formula with the best performance. MATERIALS AND METHODS: We estimated R 0 for cumulative cases count data from April 18 to July 6, 2009 and 35-2017 to 34-2018 weeks in Canada: maximum likelihood (ML), exponential growth rate (EG), time-dependent reproduction numbers (TD), attack rate (AR), gamma-distributed generation time (GT), and the final size of the epidemic. Gamma distribution with mean and standard deviation 3.6 ± 1.4 is used as GT. RESULTS: The AR method obtained a R 0 (95% confidence interval [CI]) value of 1.116 (1.1163, 1.1165) and an EG (95%CI) value of 1.46 (1.41, 1.52). The R 0 (95%CI) estimate was 1.42 (1.27, 1.57) for the obtained ML, 1.71 (1.12, 2.03) for the obtained TD, 1.49 (1.0, 1.97) for the gamma-distributed GT, and 1.00 (0.91, 1.09) for the final size of the epidemic. The minimum and maximum vaccination coverage were related to AR and TD methods, respectively, where the TD method has minimum mean squared error (MSE). Finally, the R 0 (95%CI) for 2018 data was 1.52 (1.11, 1.94) by TD method, and vaccination coverage was estimated as 34.2%. CONCLUSION: For the purposes of our study, the estimation of TD was the most useful tool for computing the R 0, because it has the minimum MSE. The estimation R 0 > 1 indicating that the epidemic has occurred. Thus, it is required to vaccinate at least 41.5% to prevent and control the next epidemic.

Determining factors influencing survival of breast cancer by fuzzy logistic regression model.

BACKGROUND: Fuzzy logistic regression model can be used for determining influential factors of disease. This study explores the important factors of actual predictive survival factors of breast cancer's patients. MATERIALS AND METHODS: We used breast cancer data which collected by cancer registry of Kerman University of Medical Sciences during the period of 2000-2007. The variables such as morphology, grade, age, and treatments (surgery, radiotherapy, and chemotherapy) were applied in the fuzzy logistic regression model. Performance of model was determined in terms of mean degree of membership (MDM). RESULTS: The study results showed that almost 41% of patients were in neoplasm and malignant group and more than two-third of them were still alive after 5-year follow-up. Based on the fuzzy logistic model, the most important factors influencing survival were chemotherapy, morphology, and radiotherapy, respectively. Furthermore, the MDM criteria show that the fuzzy logistic regression have a good fit on the data (MDM = 0.86). CONCLUSION: Fuzzy logistic regression model showed that chemotherapy is more important than radiotherapy in survival of patients with breast cancer. In addition, another ability of this model is calculating possibilistic odds of survival in cancer patients. The results of this study can be applied in clinical research. Furthermore, there are few studies which applied the fuzzy logistic models. Furthermore, we recommend using this model in various research areas.

Time interval between the onset of symptoms and diagnosis of multiple sclerosis and the influential factors: A national registry-based study.

OBJECTIVE: The time to diagnosis of multiple sclerosis (MS) is of great importance for early treatment, thereby reducing the disability and burden of the disease. The purpose of this study was to determine the time from the onset of clinical symptoms to the diagnosis of MS and to evaluate the factors associated with a late diagnosis in Iranian MS patients. METHODS: The present cross-sectional study was conducted on patients with MS who were registered in the National MS Registry System of Iran (NMSRI). RESULTS: Overall, 23291 MS patients registered in 18 provinces of Iran were included in this study. The mean (standard deviation) interval between the onset of the disease and diagnosis of MS was 13.42 (32.40) months, and the median was one month. The diagnostic interval of 41.6% of patients was less than one month, and 14.8% of them had a one-month time to diagnosis. Patients with an age of onset below 18 years and those diagnosed after the age of 50 years had a longer time to diagnosis (P<0.001). Patients with primary progressive MS (PPMS) had the longest time to diagnose and those with relapsing-remitting MS (RRMS) had the shortest time (P<0.001). The results of negative binominal regression showed that the average rate of delay in diagnosis in women was 12% less than that in men. The average delay in diagnosis in patients with a positive family history of MS was 23% more than that in others. The rate of delay in the diagnosis of patients with PPMS and secondary progressive MS was 2.22 and 1.66 times higher, respectively, compared with RRMS. CONCLUSION: The findings of the present study revealed that more than half of the MS patients were diagnosed within a one-month interval from the symptom onset, which is an acceptable period. More attention should be paid to patients' access to medical facilities and MS specialists.

A structural equation model analysis of the relationship between expectant fathers' fear of COVID-19 and their fear of childbirth: The mediating role of maternal fear of childbirth.

BACKGROUND: Pregnancy and childbirth may provoke various emotional responses in expectant fathers including excessive fear of childbirth. It is not unreasonable to assume that fear of contracting the virus during the COVID-19 pandemic, may have intensified fathers' fear of childbirth. This study aims to determine the mediating role of the expectant mothers' fear of childbirth in the relationship between expectant fathers' fear of COVID-19 and their fear of childbirth. METHODS: This cross-sectional study was conducted on 270 pregnant women and their spouses attending health centers from Aug 2021 to April 2022. Fathers' fear of childbirth scale (FFCS), Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ-A), and Fear of COVID-19 Scale (FCV-19S) were used to collect data. To examine the relationships between variables and to develop the final model, we used the structural equation model (SEM). RESULTS: The prevalence of severe fear of childbirth in fathers and their female spouses were 40.9% and 22.4%, respectively. The mean score and standard deviation of fear of childbirth in the fathers and their female spouses were 49.2 ± 17.1 and 62.5 ± 29.4, respectively. Results showed that fathers' fear of COVID-19 was directly (B = 0.44, p = 0.004) and indirectly (B = 0.13, p = 0.015) associated with fathers' fear of childbirth. Also, women's fear of childbirth was positively associated with fathers' fear of childbirth (B = 0.45, p = 0.030). In the final model, the values of χ2/df, CFI, PCFI, RMSEA, and SRMR were equal to 2.32, 0.94, 0.76, 0.07, and 0.06, respectively. CONCLUSIONS: We found a high prevalence of severe fear of childbirth in Iranian expectant fathers which means that fathers' fear of childbirth is a national health concern that needs to be addressed. The findings of the present study indicate that mothers' fear of childbirth has a mediating role in the relationship between fathers' fear of COVID and fear of childbirth. Therefore, to alleviate fathers' fear of childbirth, interventions to reduce fathers' fear of COVID-19 and women's fear of childbirth should be developed and implemented. The impact of fathers' mental health on the fear of childbirth in expectant couples should be further investigated.

Factors associated with the number of months of delaying in multiple sclerosis diagnosis: Comparison of count regression models.

Background: It may take a long time to diagnose multiple sclerosis (MS) since the emergence of primary symptoms. This study aimed to use count regression models to compare their fit and to identify factors affecting delay in the diagnosis of MS. Methods: Data were collected from the Nationwide MS Registry of Iran (NMSRI) for Mazandaran Province, Iran, using census sampling until April 2022. The four models of Poisson regression, negative binomial (NB) regression, zero-inflated Poisson (ZIP) regression, and zero-inflated negative binomial (ZINB) regression were used in this study. Results: In this study on 2894 patients, 74.0% were women, and 8.5% had a family history of MS. The mean ± standard deviation (SD) of the patients' age was 34.96 ± 9.41 years, and the mean delay in diagnosis was 12.32 ± 33.26 months, with a median of 0 (Q1-Q3: 0-9). The NB regression model showed the best performance, and factors, including a history of hospitalization and the year of symptom onset, had significant effects on a delayed diagnosis. Besides, the Expanded Disability Status Scale (EDSS) score was significantly different before and after 2017; it was also associated with sex, type of MS, and history of hospitalization. Conclusion: The mean diagnostic delay and the mean age of MS diagnosis are critical in Mazandaran Province. Patients with MS develop the disease at an early age and are diagnosed with a long delay. The time of symptom onset is a significant factor in the diagnosis of MS, and in recent years, there have been improvements in the diagnostic process.

Determining the status of preconception care model in pregnant woman of Gorgan city (North of Iran) using structural equation modeling (SEM).

BACKGROUND: Preconception reduces unplanned pregnancies and plays an important role in reducing maternal and infant mortality. Considering the importance of these care services, this study was conducted to determine the status of preconception care (PCC) model with Structural Equation Modeling (SEM). MATERIALS AND METHODS: This cross-sectional descriptive study was conducted on 394 pregnant women referring to Gorgan's health centers. Samples were selected by multi-stage stratified sampling method. The instrument used in this research was a researcher-made questionnaire by Bayrami. Data were analyzed using R software version 4.1.4. Structural equation modeling (SEM) with weighted least square mean and variance method was used to fit the conceptual model and the significance level of the tests was considered 0.05. RESULTS: The results showed that PCC model was deemed appropriate as optimum conditions indicators of goodness of fit; knowledge with a coefficient of 0.182 leads to self-efficacy (SE), and SE affects the accessibility of facilities with a coefficient of 0.465 and the expected outcome with a coefficient of 0.500. After facility structure with a coefficient of 0.500, SE construct with a coefficient of 0.215 had the most effect on performing PCC behavior. CONCLUSIONS: Facilities and SE as a key element of empowerment have an important role in promoting PCC. Identifying the factors associated with this care appears to help health policymakers to planning for these caregivers more precise and sensitive.

A structural equation model analysis of the relationship between maternal fear of childbirth and expectant fathers' fear of childbirth: The mediating role of fathers' depression, anxiety, and stress.

INTRODUCTION: Some fathers experience traumatic and unpleasant feelings such as fear of childbirth during pregnancy and childbirth. This study aimed to determine the mediating role of the expectant fathers' depression, anxiety, and stress in the relationship between maternal fear of childbirth and paternal fear of childbirth. METHODS: In this cross-sectional study, using a two-stage sampling method, 502 expectant Iranian fathers and their wives in the second half of pregnancy were recruited. The participants completed self-administered questionnaires, including the fathers' fear of childbirth scale, the Wijma delivery expectancy/experience questionnaire, and the depression, anxiety, and stress scale-21. To analyze the data, structural equation modeling was employed in the Amos software version 24. RESULTS: Results indicated an acceptable fit of the model to the data. Maternal fear of childbirth was associated with paternal fear of childbirth, directly (ß = 0.23, p = .046) and indirectly through the mediator of paternal depression, anxiety, and stress (ß = .17, p = .007). The expectant fathers' stress had a greater impact on their fear of childbirth. CONCLUSIONS: By considering the role of maternal fear of childbirth as well as expectant fathers' depression, anxiety, and stress on paternal fear of childbirth, it seems this study has some practical implications for improving the fathers' psychological well-being.

Estimation of the serial interval and basic reproduction number of COVID-19 in Qom, Iran, and three other countries: A data-driven analysis in the early phase of the outbreak.

The outbreak of COVID-19 was first reported from China, and on 19 February 2020, the first case was confirmed in Qom, Iran. The basic reproduction number (R0 ) of infection is variable in different populations and periods. This study aimed to estimate the R0 of COVID-19 in Qom, Iran, and compare it with that in other countries. For estimation of the serial interval, we used data of the 51 confirmed cases of COVID-19 and their 318 close contacts in Qom, Iran. The number of confirmed cases daily in the early phase of the outbreak and estimated serial interval were used for R0 estimation. We used the time-varying method as a method with the least bias to estimate R0 in Qom, Iran, and in China, Italy and South Korea. The serial interval was estimated with a gamma distribution, a mean of 4.55 days and a standard deviation of 3.30 days for the COVID-19 epidemic based on Qom data. The R0 in this study was estimated to be between 2 and 3 in Qom. Of the four countries studied, the lowest R0 was estimated in South Korea (1.5-2) and the highest in Iran (4-5). Sensitivity analyses demonstrated that R0 is sensitive to the applied mean generation time. To the best of the authors' knowledge, this study is the first to estimate R0 in Qom. To control the epidemic, the reproduction number should be reduced by decreasing the contact rate, decreasing the transmission probability and decreasing the duration of the infectious period.

Differential regulatory effects of chemotherapeutic protocol on CCL3_CCL4_CCL5/CCR5 axes in acute myeloid leukemia patients with monocytic lineage.

AIMS: AML (Acute myeloid leukemia) is characterized as a heterogeneous cancer. Chemokines play fundamental roles in the onset, progression cellular, migration, survival and improvement of AML therapy outcomes. The CCR5 receptors together with their ligands have indirect effects on the progression of cancer. In the present study, we have decided to investigate the impact of chemotherapy on the expression of CCR5 and its related ligands (CCL5, CCL4 and CCL3). MAIN METHODS: In this study, peripheral blood and bone marrow specimens were collected prior and post the first stage of (7 + 3) chemotherapy from 25 AML-M4/M5 patients. The expression of CCR by Lymphocytes in peripheral blood was examined by flow cytometry and QRT-PCR. The serum levels of chemokines were measured by ELISA. KEY FINDINGS: There was not observed leukemic blast cells in peripheral blood smear at post first stage of chemotherapy. We found that the expression of CCR5 was attenuated in patients post the first stage of chemotherapy and the healthy control subjects. We have also observed that the serum levels of chemokines were elevated in AML patients prior to chemotherapy. Although in post-chemotherapy stage, only CCL3 was found to reach to the baseline level, CCL5 and CCL4 have not returned to the basal level and were significantly higher than healthy control subjects. SIGNIFICANCE: The current chemotherapy protocol was not able to completely inhibit CCL5 and CCL4. In conclusion, our findings in harmony with previous studies suggest that inhibition of chemokines along with chemotherapy in AML patients may aid therapy.

Awareness and Attitude Towards Opioid and Stimulant Use and Lifetime Prevalence of the Drugs: A Study in 5 Large Cities of Iran.

BACKGROUND: Providing population-based data on awareness, attitude and practice of drug and stimulant use has policy implications. A national study was conducted among Iranian general population to explore life time prevalence, awareness and attitudes toward opioids and stimulant use. METHODS: We recruited subjects from 5 provinces with heterogenic pattern of drug use. Participants were selected using stratified multistage cluster sampling. Data were collected using a validated self-administered questionnaire. Logistic regression model was applied to identify the variables that are associated with drug and stimulant use. RESULTS: In total 2065 respondents including 1155 men (33.96 ± 10.40 years old) and 910 women (35.45 ± 12.21 years old) were recruited. Two-third of respondents had good awareness about adverse effects of opioid use. Corresponding figure in terms of stimulants was 81.4%. Almost 95% of participants reported a negative attitude towards either opioid or stimulant use. The lifetime prevalence of opioid use and stimulant use were 12.9% (men: 21.5%, women: 4.0%) and 7.3% (men: 9.6%, women: 4.9%), respectively. Gender (adjusted odds ratio [AOR]M/W=6.92; 95% CI: 2.92, 16.42), education (AORundergraduate/diploma or less =0.49; 95% CI: 0.26, 0.90), and marital status (AORothers/single=2.13; 95% CI: 1.36, 3.33) were significantly related with opioid use. With respect to stimulant use, age was negatively associated with the outcome (AOR60+/20-29 years = 0.08: 95% CI; 0.01, 0.98) and men were 2 times more likely than women to use stimulants (ORM/W=2.15: 95% CI: 0.83, 5.56). In addition, marital status (AOROthers/singles = 3.45; 95% CI: 1.09, 10.93), and awareness (AORWeak and moderate/good =0.40; 95% CI: 0.25, 0.61) were independently correlated with stimulants use. CONCLUSION: While the attitude of Iranian adults toward opioid and stimulant use was negative, their awareness was not that adequate to prevent the drug use. Men and those with lower socio-economic status (SES) should be the focus of health promotion programs regarding opioid use. However, regarding stimulants use, promotion programs should target younger age groups and those with higher SES status.

Estimation of the Basic Reproduction Number and Vaccination Coverage of Influenza in the United States (2017-18).

BACKGROUND: Determining the epidemic threshold parameter helps health providers calculate the coverage while guiding them in planning the process of vaccination strategy. Since the trend and mechanism of influenza is very similar in different countries, we planned a study with the mentioned goal by using data of US from 2017 to 2018. STUDY DESIGN: A secondary study. METHODS: R0 and corresponding vaccination coverage are estimated using the national and state-level data of the US from the 40th in 2017 to the 5th week in 2018. Four methods maximum likelihood (ML), exponential growth (EG), time-dependent reproduction numbers (TD), and sequential Bayesian (SB) are used to calculate minimum vaccination coverage. The gamma distribution is considered as the distribution and the generation of time. RESULTS: The peak of epidemy in most states has occurred in the 15th week after the beginning of the epidemics. The generation time obey the Gamma distribution with mean and standard deviation of 3.6 and 1.6, respectively, was utilized for the generation time. The R0 (vaccination coverage) equaled 1.94 (48.4%), 1.80 (44.4%), 3.06 (67.3%), and 2.11 (52.6%) for EG, ML, SB, and TD methods at the national level, respectively. CONCLUSION: The R0 estimations were in the range of 1.8-3.06, indicating that an epidemic has occurred in the US (R0>1). Thus, it is required to vaccinate at least 44.4% to 67.3% to prevent the next epidemics of influenza. The findings of this study assist futures studies to apply disease control by vaccination strategies in order to prevent a national disaster.

Effects of α-thalassaemia mutations on the haematological parameters of ß-thalassaemia carriers.

BACKGROUND: Thalassaemia is a haemoglobin disorder caused by a reduction in, or a complete absence of, the production of α- or ß-globin genes. Detection of ß-thalassaemia carriers is the first step in the prenatal diagnosis of the disease and is based primarily on the differences between levels of blood cell indices. Since co-inheritance of ß- and α-thalassaemia mutations modulates the haematological parameters of heterozygote ß-thalassaemia indices, understanding the influence of this interaction is helpful for identification of disease carriers. OBJECTIVE: To determine the effects of α-thalassaemia mutations on the haematological parameters of ß-thalassaemia carriers. METHOD: We used gap-PCR and amplification refractory mutation system techniques to find any α- and/or ß-thalassaemia mutations in 270 subjects who were suspected to be thalassaemia carriers. The mean values of the haematological parameters in α, ß-thalassaemia and ß-thalassaemia carriers were compared. RESULTS: Significant differences in mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH) and HbA2 were found between the two groups. Patients who were α, ß-thalassaemia carriers had higher mean values of MCV and MCH, whereas HbA2 levels were higher in simple ß-thalassaemia. No marked differences were found in mean cell haemoglobin (Hb) concentration and Hb blood cell indices. The value of MCV, MCH and HbA2 were significantly different between α,ß-thalassaemia and simple ß-thalassaemia in men and women, but the mean values of Hb in the two groups differed markedly only in men. CONCLUSION: We conclude that co-inheritance of α- and ß-thalassaemia mutations may result in misdiagnosis of ß-thalassaemia carriers. Therefore, in genetic counselling of patients with a near-normal range of blood cell indices the possibility that they may carry α, ß-thalassaemia mutations must be considered.

Comparison of nasal intermittent positive pressure ventilation and nasal continuous positive airway pressure treatments using parametric survival models.

OBJECTIVE: The Cox model is the dominant tool in clinical trials to compare treatment options. This model does not specify any specific form to the hazard function. On the other hand, parametric models allow the researcher to consider an appropriate shape of hazard function for the event of interest. The aim of this article is to compare performance of Cox and parametric models. METHODS: We used data collected in a prospective clinical trial that aimed to compare performance of nasal intermittent positive pressure ventilation (NIPPV) and nasal continuous positive airway pressure (NCPAP) treatments in terms of survival of newborn infants who had respiratory distress syndrome (RDS). Performance of Cox, exponential, Weibull, and log-logistic models were compared in terms of goodness of fit. FINDINGS: Fitting the Cox model, we have seen that infants who received NCPAP were 4.23 (Hazard Ratio= 4.23, 95% Confidence Interval: 1.87-9.59) times more likely to fail than those received NIPPV (P=0.001). Adequacy of the exponential model was rejected. We have seen a decreasing hazard rate over time, in both treatment groups. This decrease was sharper in NCPAP group. Akiake information criterion corresponded to the log-logistic model and was lower than all other models followed by Weibull model. CONCLUSION: Our results demonstrate the benefit of parametric survival models over traditional Cox regression model in terms of modeling of shape of hazard function. We saw a decreasing hazard that confirms the flexibility of parametric models in terms of the modeling of hazard rate.