Analysis of the survival time of patients with heart failure with reduced ejection fraction: a Bayesian approach via a competing risk parametric model.

PURPOSE: Heart failure (HF) is a widespread ailment and is a primary contributor to hospital admissions. The focus of this study was to identify factors affecting the extended-term survival of patients with HF, anticipate patient outcomes through cause-of-death analysis, and identify risk elements for preventive measures. METHODS: A total of 435 HF patients were enrolled from the medical records of the Rajaie Cardiovascular Medical and Research Center, covering data collected between March and August 2018. After a five-year follow-up (July 2023), patient outcomes were assessed based on the cause of death. The survival analysis was performed with the AFT method with the Bayesian approach in the presence of competing risks. RESULTS: Based on the results of the best model for HF-related mortality, age [time ratio = 0.98, confidence interval 95%: 0.96-0.99] and ADHF [TR = 0.11, 95% (CI): 0.01-0.44] were associated with a lower survival time. Chest pain in HF-related mortality [TR = 0.41, 95% (CI): 0.10-0.96] and in non-HF-related mortality [TR = 0.38, 95% (CI): 0.12-0.86] was associated with a lower survival time. The next significant variable in HF-related mortality was hyperlipidemia (yes): [TR = 0.34, 95% (CI): 0.13-0.64], and in non-HF-related mortality hyperlipidemia (yes): [TR = 0.60, 95% (CI): 0.37-0.90]. CAD [TR = 0.65, 95% (CI): 0.38-0.98], CKD [TR = 0.52, 95% (CI): 0.28-0.87], and AF [TR = 0.53, 95% (CI): 0.32-0.81] were other variables that were directly related to the reduction in survival time of patients with non-HF-related mortality. CONCLUSION: The study identified distinct predictive factors for overall survival among patients with HF-related mortality or non-HF-related mortality. This differentiated approach based on the cause of death contributes to the estimation of patient survival time and provides valuable insights for clinical decision-making.

Long-term outcomes of non-metastatic breast cancer patients by molecular subtypes.

BACKGROUND: Today, with the progress of medical sciences, increasing the cure probability and survival time is an important goal of cancer treatment. This study compared long-term disease-free survival (DFS) of non-metastatic breast cancer patients based on different molecular subtypes. METHODS: This retrospective cohort study consisted of 1287 patients diagnosed with breast cancer and treated at Motamed Cancer Institute from 2000 to 2016 and followed up until 2018. Kaplan-Meier curve was fitted to data based on molecular subtypes. Then the semi-parametric mixture cure model was applied to determine the survival and cure probability of molecular subtypes by adjusting clinical and demographic factors. RESULTS: Among 1287 breast cancer patients, 200 (15.5%) cases died. The mean age of patients was 47.00 ± 10.72 years. Women with the HR+/HER2-subtype had the best 5-year survival rate (84.2%), whereas other subtypes had a lower rate as follows: HR+/HER2+ (77.3%), triple-negative (76.5%), and HR-/HER2+ (62.3%). Kaplan-Meier curve calculated a cure rate of about 60% and patients who survived more than 150 months were intuitively considered cured. After adjustment for clinical and demographic variables, the cure probability of HR-/Her2+ patients was substantially lower than HR+/HER2- patients (OR = 0.22), though there were no significant variations in short-term DFS based on molecular subtypes (HR = 0.91). CONCLUSIONS: Our results confirm that the most prevalent breast cancer was HR+/HER2- tumor type which had the best prognosis. It is also concluded that HR-/HER2+ patients had the worst outcomes, with the highest rates of recurrence and metastasis and the lowest overall and disease-free survival rates.

Identification of associated risk factors for the severity of generalized anxiety disorder among Iranian infertile people: An ordinal regression analysis with a flexible link function.

BACKGROUND: Generalized anxiety disorder (GAD) is a common disorder in infertile people. The aim of this study was the identification of associated risk factors for the severity of GAD in infertile people using an ordinal model with a flexible link function. MATERIALS AND METHODS: This cross-sectional study was conducted on 1146 individuals with a couple's infertility problem selected from an infertility center in Tehran, Iran. Data collected using self-administered questionnaires include demographic/clinical information and GAD-7. We used a Bayesian-ordered symmetric power logit (splogit) model to identify the risk factors for the severity of GAD. Furthermore, we implemented standard ordinal models to compare with the ordered splogit model. RESULTS: Female gender (B coefficient 0.48, 95% credible interval [CrI]: 0.34-0.62), longer duration of infertility (B coefficient 0.03, 95% CrI: 0.01-0.04), previous treatment failure (B coefficient 0.17, 95% CrI: 0.03-0.30), and self-cause of infertility (B coefficient 0.12, 95% CrI: 0.01-0.23) were associated factors with the severity of GAD. The splogit model had a better fit and performance to determine the associated risk factor for the severity of GAD as compared to standard models. It provided more precise estimates of risk factors and one more significant risk factor. CONCLUSION: Infertile people with female gender, longer duration of infertility, failure in previous treatments, and self-cause infertility are more likely to experience higher severity levels of GAD and require additional psychological, and support interventions. Furthermore, it can be argued that the ordinal splogit model is more powerful to identify the associated risk factors for the severity of GAD.

Kernel and regression spline smoothing techniques to estimate coefficient in rates model and its application in psoriasis.

Background: Data types are recurrent events in studies in which each person may experience an event at different times. One of the most popular approaches to analyze recurrent event data is obtaining an estimate of the means/rate of events at different times. In this context, determining the variability over time can help better understand the effect of factor on the response. In this study, we applied smoothing methods to estimate coefficients in time-dependent rate model, and we also showed its application in data of psoriasis patients. Methods: In the present study, psoriasis patients who experienced relapse that led to hospitalization during 2005 and 2014 in the Dermatology Department of Imam Khomeini hospital in Tehran were examined. To investigate the rate of relapse during a year, time-dependent rate model was used and variability of the effects was assessed using Wald test. Both b-spline and kernel methods were used to estimate time varying coefficients in rates model. Finally, results from methods were compared based on the obtained estimates. Results: Based on the results of the Wald test, the effect of season on the occurrence of psoriasis was significantly different (p<0.01). Also according to the estimated coefficients from both b-spline and kernel methods, there was little difference between them. Conclusion: In situations in which the effect of a variable is different at different times, using time-dependent coefficients rate model can lead to a better estimate of the effect of variable on the response. On the other hand, smoothing methods can smooth the effects of the variables that vary over time.

Women's sexual and reproductive health care needs assessment: an Iranian perspective.

BACKGROUND: Reproductive health problems are a leading cause of women's ill health and mortality worldwide. There is a need to investigate sexual and reproductive health care needs in different societies and cultural contexts. Despite the success in health care promotion in the Iranian health care system, women still need to receive sexual health care and appropriate HIV/AIDS services. However, studies on the sexual and reproductive health care needs of Iranian women are lacking. AIMS: This study aimed to investigate the sexual and reproductive health care needs of women referred to health care centres in an urban area of the Islamic Republic of Iran. METHODS: We carried out a cross-sectional study in 2013 on 514 women living in an urban area in the north of the Islamic Republic of Iran. Taking into consideration ethical principles, data were collected using the Sexual and Reproductive Health Care Needs Assessment Questionnaire. RESULTS: The findings showed a greater need for the provision of care by practitioners in the sexual history and activities domain (73%) compared with other domains. Also, the woman's age and the location where she sought treatment and care for sexually transmitted infections were predictors of sexual activities needs. CONCLUSIONS: Owing to the high prevalence of women's referral to health care centres seeking treatment of sexual disorders, there is a need for the provision of sexual counseling centres and services promoting women's reproductive health care.

Translation and psychometric testing of the Farsi version of the Seattle angina questionnaire.

BACKGROUND: Angina pectoris causes substantial psychological and functional disabilities and adversely effects quality of life in patients. The aim of this study was to investigate the psychometric properties including validity and reliability of the Farsi version of the Seattle angina questionnaire. METHODS: The 'forward-backward' procedure was applied to translate this questionnaire from English to Farsi. The translated version of the Seattle angina questionnaire was assessed in terms of validity and reliability with a convenience sample of 200 patients suffering from angina pectoris who were recruited from the inpatient ward (post CCU) and outpatient department at two teaching hospitals in an urban area of Iran. Validity was assessed using content, face and construct validity. The calculation of the Cronbach's alpha coefficient and the test-retest method helped with the assessment of reliability of the questionnaire's five subscales. Construct validity of the questionnaire was evaluated using exploratory factor analysis. RESULTS: The results of exploratory factor analysis indicated a five-factor solution for the questionnaire including 'physical limitation in middle to strenuous activities', 'physical limitation in slight activities', 'angina pattern and discomfort of treatment', 'treatment satisfaction' and 'disease perception' that jointly accounted for 64.42% of variance observed. Convergent validity was mostly supported by the pattern of association between the Seattle angina questionnaire-Farsi version and the SF-36. Cronbach's alpha of the subscales ranged from 0.60 to 0.86 and test-retest scores ranged from 0.79 to 0.97 indicating a good range of reliability. CONCLUSIONS: The Seattle angina questionnaire-Farsi version had acceptable psychometric properties. Therefore, it can be used to assess health-related quality of life and assess the effects of different medical and nursing interventions on patients' quality of life.

Investigation factors affecting the first recurrence of coronary artery disease in patients undergone angioplasty using cox survival model.

Background: The incidence of restenosis in patients suffering from coronary artery disease after undergoing angioplasty is of paramount importance. Accordingly, this study aimed to investigate factors affecting the time of the first incidence of restenosis in patients undergone angioplasty in the city of Zanjan, Iran. Methods: This retrospective cohort study was conducted on 421 patients who referred to Ayatollah Musavi hospital in Zanjan for angioplasty during 2009 to 2012. The time of the incidence of restenosis after angioplasty constituted the dependent variable of the study. Independent variables of the study included signs of diabetes, hypertension, hyperlipidemia, kidney disease, carotid stenosis, lung disease, anemia, angina history, and MI. The Cox regression model with the significance level of 0.05 was deployed for the statistical analysis. Results: According to the Cox regression model, hazard ratio of the first incidence of restenosis in patients with hypertension and angina was 22.8% and 29.5% less than other patients, respectively. However, hazard ratio of the first incidence of restenosis was 7.4 times more in patients suffering from carotid stenosis than other patients (p<0.05). Conclusion: The results of this study revealed that as time goes on, the risk of the incidence of restenosis in angioplasty patients increases such that patients' survival decreases dramatically after a year. To determine the role of effective factors on the incidence of restenosis, conducting a prospective interventional study is highly recommended.

Clinical diagnosis of pelvic endometriosis: a scoping review.

BACKGROUND: Accurate and timely diagnosis of endometriosis is associated with confusion. Clinical manifestations, imaging techniques, biomarkers and surgical techniques are used as diagnostic approaches. This paper reviews current evidence on clinical manifestation in order to help practitioners and perhaps improve women's health. METHODS: A review of the literature on clinical diagnosis of pelvic endometriosis that appeared in the English language biomedical journals was performed using PubMed, Science Direct and Google Scholar. The search strategy included the combination of key words 'endometriosis' and 'diagnosis' or 'clinical diagnosis' in the titles or abstracts of articles. The search included all papers published during the year 2000 to 2014. Then, the findings were classified in order to summarize the evidence. RESULTS: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, in all 51 papers were found relevant and included in this review. In general we found three categories of diagnostic approaches for clinical manifestation including: i) diagnosis via symptoms obtained from history taking, ii) diagnosis via signs obtained from physical examination and iii) diagnosis via risk factors obtained from history taking. CONCLUSION: Diagnosis of endometriosis is a matter of concern. Since the disease is associated with diverse clinical symptoms and signs, deeper and more comprehensive consideration according to patient's history and clinical findings is recommended for early and more accurate detection in order to prioritize women for further investigation and contribute to its early management.

Prediction of unwanted pregnancies using logistic regression, probit regression and discriminant analysis.

BACKGROUND: Unwanted pregnancy not intended by at least one of the parents has undesirable consequences for the family and the society. In the present study, three classification models were used and compared to predict unwanted pregnancies in an urban population. METHODS: In this cross-sectional study, 887 pregnant mothers referring to health centers in Khorramabad, Iran, in 2012 were selected by the stratified and cluster sampling; relevant variables were measured and for prediction of unwanted pregnancy, logistic regression, discriminant analysis, and probit regression models and SPSS software version 21 were used. To compare these models, indicators such as sensitivity, specificity, the area under the ROC curve, and the percentage of correct predictions were used. RESULTS: The prevalence of unwanted pregnancies was 25.3%. The logistic and probit regression models indicated that parity and pregnancy spacing, contraceptive methods, household income and number of living male children were related to unwanted pregnancy. The performance of the models based on the area under the ROC curve was 0.735, 0.733, and 0.680 for logistic regression, probit regression, and linear discriminant analysis, respectively. CONCLUSION: Given the relatively high prevalence of unwanted pregnancies in Khorramabad, it seems necessary to revise family planning programs. Despite the similar accuracy of the models, if the researcher is interested in the interpretability of the results, the use of the logistic regression model is recommended.

The Mother-Newborn Skin-to-Skin Contact Questionnaire (MSSCQ): development and psychometric evaluation among Iranian midwives.

BACKGROUND: Despite the benefits of mother-newborn skin-to-skin contact immediately after birth, it has not been universally implemented as routine care for healthy term neonates. Midwifes are the first person to contact the neonate after birth. However, there is evidence that many midwives do not perform mother-newborn skin-to-skin contact. The aim of this study was to develop and psychometrically evaluate an instrument for measuring factors associated with mother-newborn skin-to-skin contact (MSSCQ) based on the PRECEDE-PROCEED model. METHODS: This was a two-phase qualitative and quantitative study. It was conducted during 2010 to 2012 in Tehran, Iran. In the qualitative part, 150 midwives working in labor room participated in 19 focus group discussions in order to generate a preliminary item pool. Then, content and face validity were performed to provide a pre-final version of the questionnaire. In the quantitative phase, reliability (internal consistency and test-retest analysis), validity and factor analysis (both exploratory and confirmatory) were performed to assess psychometric properties of the instrument. RESULTS: A 120-item questionnaire was developed through the qualitative phase. It was reduced to an 83-item after content validity. The exploratory factor analysis loaded fifteen-factors and three constructs (predisposing, enabling and reinforcing) containing 82 items (38, 18, and 26 statements, respectively) that jointly accounted for 60.61% of observed variance. The Confirmatory factors analysis determined a model with appropriate fitness for the data. The Cronbach's alpha coefficient showed excellent internal consistency (alpha = 0.92), and test-retest of the scale with 2-week intervals indicated an appropriate stability for the MSSCQ (ICC = 0.94). CONCLUSION: The Mother-Newborn Skin-to-Skin Contact Questionnaire (MSSCQ) is a reliable and valid theory-based measurement and now can be used in clinical practice, midwifery and nursing studies.

Patients' and physicians' descriptions of occurrence and diagnosis of endometriosis: a qualitative study from Iran.

BACKGROUND: The prevalence of endometriosis is considerable but its diagnosis is a dilemma. The aim of this study was to explore the perception and experiences of endometriosis patients and physicians about occurrence and diagnosis of endometriosis. METHODS: A qualitative research using content analysis was used to obtain data from purposely selected endometriosis patients (12 participants) and gynecologists (6 participants) from January to September 2013 in Tehran. Data were coded and analyzed using a thematic approach. RESULTS: Seven themes emerged: 1) pain localization, 2) Severity of pain and struggle for pain relief, 3) Feeling inability to play the role of femininity, 4) Reducing physical health, 5) Disruption of social life, 6) Looking for a reliable diagnostic indicator, 7) Uncertainty of physical examination. The results highlighted that patients with the disease can experience different feelings that interfere with their wellbeing and their lives, and sometimes could be disabling. CONCLUSION: Patients and physicians are looking for a certain, noninvasive and inexpensive diagnostic method. This study helps to promote clinical diagnostic view and knowledge development about description of endometriosis diagnosis to decrease diagnostic delay and mismanagement.

Brushing behavior among young adolescents: does perceived severity matter.

BACKGROUND: Oral health is a basis for general health and well-being and affects physical and psychological aspects of the human life. The aim of this study was to determine the power of the health belief model in general and the role of perceived severity and its components in particular in predicting tooth brushing behavior among young adolescents. METHODS: This was a cross sectional study of a sample of female students grade four in Rasht (a metropolitan in north Iran) in 2012. A systematic random sampling method was applied to recruit students. They were asked to respond to a designed questionnaire containing items on brushing behavior based on the health belief model. In this study for the first time perceived severity and perceived barriers were divided into two parts, perceived subjective and objective severity and perceived physical and psychological barriers and were treated as independent variables. Logistic regression analysis was performed in order to identify the variables that predict the desirable behavior (brushing twice a day or more). RESULTS: In all 265 female students were entered into the study. Of these, only 17.4% reported that they were brushing at least twice a day (desirable behavior). The results obtained from the logistic regression analysis indicated that perceived objective severity (OR = 0.37, 95% CI = 0.21- 0.66, P = 0.001) and feeling less perceived psychological barriers (OR = 2.60, 95% CI = 1.50- 4.52, P = 0.001) were the significant predicting factors for brushing twice a day. CONCLUSION: The findings suggest that perceived objective severity and perceived psychological barriers play important role in adapting a desirable health behavior among young adolescents.

Development and validation of a health belief model based instrument for measuring factors influencing exercise behaviors to prevent osteoporosis in pre-menopausal women (HOPE).

BACKGROUND: The health belief model (HBM) is the most commonly used conceptual framework for evaluating osteoporosis health belief and behaviors. The purpose of this study was to develop and evaluate the psychometric properties of a health belief model based questionnaire for exercise behavior for preventing osteoporosis among women aged 30 years and over. METHODS: This was a cross sectional study of a convenience sample of women aged 30 years and over in Tehran, Iran using a theory-based instrument (HOPE). The instrument contained 39 items covering issues relate to osteoporosis prevention behavior. In this methodological study, exploratory and confirmatory factor analyses were used for psychometric evaluation. The Cronbach's alpha coefficient and Intraclass Correlation Coefficient (ICC) was used to evaluate the reliability of the scale. RESULTS: In all 240 women participated in the study. The mean age of participant was 39.2 ± 7.8 years. The initial analysis extracted nine factors for the questionnaire that jointly accounted for 66.5% of variance observed. Confirmatory factor analysis showed that the data obtained was fit with Health Belief Model (HBM) and self-regulation construct (X2 = 1132.80, df = 629, P < 0.0001, CFI = 0.94, GFI = 0.91, RMSEA = 0.05 and SRMR = 0.06). The Cronbach's alpha coefficient for the subscales ranged from 0.72 to 0.90 and Intraclass Correlation Coefficient (ICC) ranged from 0.71 to 0.98; well above acceptable thresholds. CONCLUSIONS: The HOPE was found to be appropriate instrument for measuring health belief and self-regulation for prevention of osteoporosis.

Development and psychometric evaluation of the Premarital Sexual Behavior Assessment Scale for Young Women (PSAS-YW): an exploratory mixed method study.

BACKGROUND: Premarital sexual behaviors are important issue for women's health. The present study was designed to develop and examine the psychometric properties of a scale in order to identify young women who are at greater risk of premarital sexual behavior. METHOD: This was an exploratory mixed method investigation. Indeed, the study was conducted in two phases. In the first phase, qualitative methods (focus group discussion and individual interview) were applied to generate items and develop the questionnaire. In the second phase, psychometric properties (validity and reliability) of the questionnaire were assessed. RESULTS: In the first phase an item pool containing 53 statements related to premarital sexual behavior was generated. In the second phase item reduction was applied and the final version of the questionnaire containing 26 items was developed. The psychometric properties of this final version were assessed and the results showed that the instrument has a good structure, and reliability. The results from exploratory factory analysis indicated a 5-factor solution for the instrument that jointly accounted for the 57.4% of variance observed. The Cronbach's alpha coefficient for the instrument was found to be 0.87. CONCLUSION: This study provided a valid and reliable scale to identify premarital sexual behavior in young women. Assessment of premarital sexual behavior might help to improve women's sexual abstinence.

Factors influencing unsafe behaviors and accidents on construction sites: a review.

OBJECTIVE: Construction is a hazardous occupation due to the unique nature of activities involved and the repetitiveness of several field behaviors. The aim of this methodological and theoretical review is to explore the empirical factors influencing unsafe behaviors and accidents on construction sites. METHODS: In this work, results and findings from 56 related previous studies were investigated. These studies were categorized based on their design, type, methods of data collection, analytical methods, variables, and key findings. A qualitative content analysis procedure was used to extract variables, themes, and factors. In addition, all studies were reviewed to determine the quality rating and to evaluate the strength of provided evidence. RESULTS: The content analysis identified 8 main categories: (a) society, (b) organization, (c) project management, (d) supervision, (e) contractor, (f) site condition, (g) work group, and (h) individual characteristics. The review highlighted the importance of more distal factors, e.g., society and organization, and project management, that may contribute to reducing the likelihood of unsafe behaviors and accidents through the promotion of site condition and individual features (as proximal factors). CONCLUSION: Further research is necessary to provide a better understanding of the links between unsafe behavior theories and empirical findings, challenge theoretical assumptions, develop new applied theories, and make stronger recommendations.

The transtheoretical model (TTM) questionnaire for smoking cessation: psychometric properties of the Iranian version.

BACKGROUND: The transtheoretical model (TTM) is a common framework for studies of smoking cessation. Using the TTM, several instruments were developed to measure to what extent interventions could make changes in people's behavior. The current study aimed to test the validity and reliability of the Persian version of a TTM based questionnaire for smoking cessation in Iran. METHODS: This was a cross-sectional validation study among adult male smokers using the TTM Questionnaire. Backward-forward procedure was applied to translate the questionnaire from English into Persian (the Iranian language). The confirmatory factor analyses were performed to test validity. The internal consistency and stability of the questionnaire was examined using Cronbach's alpha coefficient and Intraclass Correlation Coefficient (ICC). RESULTS: In all 150 male smokers were entered into the study. The mean age of participants was 36.51 ± 7.94 years. The results obtained from confirmatory factor analysis revealed that the data was fit to the model: the goodness of fit index (GFI) = 0.92; the comparative fit index (CFI) = 0.91; the root mean square error of approximation (RMSEA) = 0.065 (95% CI = 0.063-0.067), and the relative chi-square (x²/df) = 1.87, p < 0.001. The Cronbach's alpha ranged from 0.60 to 0.84 indicating an acceptable result. Also Intraclass Correlation of Coefficient (ICC) ranged from 0.61 to 0.83 corresponding to a satisfactory finding. CONCLUSION: The current study provided psychometric evidence for an appropriate, reliable, and valid tool to determine smoking behaviors among Iranian adult smokers. Indeed the findings from this study could be applied in designing smoking cessation interventions in Iran.

The sexual quality of life-female (SQOL-F) questionnaire: translation and psychometric properties of the Iranian version.

BACKGROUND: Female sexual dysfunction is a common condition that extremely affects reproductive health and quality of life. To assess this health condition, a valid and reliable questionnaire is required. The aim of this study was to translate and validate the Sexual Quality of Life-Female (SQOL-F) questionnaire in Iran. METHOD: Forward-backward procedure was applied to translate the questionnaire from English into Persian. After linguistic validation and pilot examination, a cross-sectional study was carried out and psychometric properties of the Iranian version of questionnaire were tested. One hundred reproductive aged, married, healthy and sexually active women completed the questionnaire. Reliability was assessed by internal consistency (Cronbach's alpha), and test-retest (intraclass correlation coefficient) analyses. In addition, content, and face validity were assessed and the factor structure of the questionnaire was extracted by performing exploratory factor analysis. RESULTS: The mean age of participants was 33 (SD = 8.07) years, and the mean quality of sexual life score was 86.4 (SD = 1.78) ranging from 36 to 108. Most women were housewife (n = 92). Reliability evaluation revealed high internal consistency and good test-retest reliability. The Cronbach's alpha coefficient was 0.73 and intraclass correlation coefficient (ICC) was 0.88. The mean scores for the content validity index (CVI) and the content validity ratio (CVR) were 0.91 and 0.84, respectively. The results of exploratory factor analysis (EFA) indicated a four-factor solution for the questionnaire that jointly accounted for 60.8% of variance observed. CONCLUSION: The findings from this study suggest that the Iranian version of SQOL-F questionnaire has good psychometric properties and it will be useful to assess the female sexual quality of life in reproductive health care settings.

Evaluation Factors Affecting on Recurrence, Metastasis, and Survival of Breast Cancer in Iranian Women by Multi-State Model Approach.

Background: We used the multistate model to investigate how prognostic factors of breast cancer are seen to affect the disease process. Methods: This cohort study was conducted at Motamed Cancer Institute of Tehran, Iran on 2363 breast cancer patients admitted from 1978 to 2017, and they were followed up until 2018. We applied the multistate models, including four states: diagnosis, recurrence, metastasis, and final absorbing mortality state. Results: Age over 50 years, positive lymph nodes and tumor size intensified the hazard of transition from diagnosis to metastasis (P=0.002, P<0.001 and P=0.001 respectively) and they also intensified the hazard of transition from diagnosis to mortality (P=0.010, P<0.001 and P<0.001 respectively). At the same time, the educational level decreased the hazard of mentioned transitions (P<0.001). Positive estrogen receptors reduced the hazard of transition from diagnosis to metastasis (P=0.007) and positive lymph nodes also intensified the hazard of transition from metastasis to mortality (P=0.040). Tumor size had an increasing role in the transitions from diagnosis to recurrence, recurrence to metastasis, and metastasis to mortality (P=0.014, P=0.018 and P=0.002 respectively). Conclusion: Multistate model presented the detailed effects of prognostic factors on progression of breast cancer. Implementing early diagnosis strategies and providing informational programs, especially in younger ages and lower educational level patients may be helpful in reducing the hazard of transition to higher states of breast cancer and increasing the survival of Iranian women with breast cancer by controlling tumor size growth, lymph nodes involvements and estrogen receptor status.

Combination effect of PectaSol and Doxorubicin on viability, cell cycle arrest and apoptosis in DU-145 and LNCaP prostate cancer cell lines.

The effect of PectaSol on Dox (Doxorubicin) cytotoxicity in terms of apoptosis and cell cycle changes in PCa (prostate cancer) cell lines (DU-145 and LNCaP) has been investigated. Combination of PectaSol and Dox resulted in a viability of 29.4 and 32.6% (P<0.001) in DU-145 and LNCaP cells. The IC50 values decreased 1.5-fold and 1.3-fold in the DU-145 and LNCaP cells respectively. In the DU-145 cells, combination of PectaSol and Dox resulted in a reduction in p27 gene and protein expression (P<0.001). In LNCaP cells, this combination increased p53, p27 and Bcl-2 expression. Treatment with both drugs in DU-145 cells led to an increase in sub-G1 arrest (54.6% compared with 12.2% in Dox). In LNCaP cells, combination of the drugs led to an increased in G2/M arrest (61.7% compared with 53.6% in Dox). Based on these findings, progressive cytotoxicity effect of Dox and PectaSol together rapidly induce cell death in DU-145 through apoptosis and in LNCaP cells through cell cycle arrest (G2/M arrest).

Barriers to condom use among women at risk of HIV/AIDS: a qualitative study from Iran.

BACKGROUND: The growing trend of women infected with HIV through sexual transmission is alarming. Factors influencing condom use have not yet been fully identified, especially in countries with conservative cultures and backgrounds. The present study aimed to explore the barriers of condom use in Iranian women at risk of HIV. METHODS: Using the grounded theory methodology, participants' experiences and their perceptions regarding condom were collected during semi structured in depth interviews. Participants were 22 women, aged 21-49 years, considered to be at risk for HIV, due to their own or their partner's sexual behaviors. Qualitative analysis of the data was conducted manually and was guided by constant comparative analysis. RESULTS: Two main barriers, personal and socio-environmental emerged from data analysis. Lack of perceived threat, absence of protective motivation, inadequate knowledge, perceived lack of control, negative attitudes towards condom and misperception were the major personal barriers, while unsupportive environments and cultural norms were the common socio-environmental barriers to condom use among these at risk women. CONCLUSIONS: These critical barriers have to be addressed for implementing effective prevention programs against HIV among populations at risk for HIV.