Analyzing the long-term survival of the patients undergoing peritoneal dialysis in the peritoneal dialysis center in Shiraz, 2002-2011.

One of the advantages of peritoneal dialysis (PD) compared to hemodialysis is it can be performed at home. The present study aims at determining the long-term survival of patients and technique survival and investigates the risk factors affecting the mortality rate in PD patients. The study was conducted on 290 patients undergoing PD in the main PD center in Shiraz, Iran, between April 2002 and March 2012. The patients' survival rate and the factors affecting their survival were assessed using the Kaplan-Meier method. Besides, log-rank method was used to compare survival among different levels of the categorized variables. Cox regression model was used for introducing the risk factors affecting the patients' survival. The mean of the patients' survival at the end of the follow-up period was 15.42 ± 13.97 months. The patients' 1-, 2-, 3-, and 5-year survival rates were 85%, 72%, 57%, and 22%, respectively, and the median survival time was 11.64 months. Forty-three patients (14.8%) changed their treatment method to hemodialysis. The patients' 1-, 2-, 3-, and 5-year technique survival rates were 90%, 81%, 72%, and 47%, respectively. Age and hemoglobin level were the most significant factors in the patients' survival. Hemoglobin level was the most important factor in technique survival.

Non-medical factors affecting antenatal preferences for delivery route and actual delivery mode of women in southwestern Iran.

OBJECTIVE: Assessment of the contribution of non-medical factors to mode of delivery and birth preference in Iranian pregnant women in southwestern Iran. STUDY DESIGN: This cohort study used data from a structured questionnaire completed in early pregnancy and information about the subsequent delivery obtained through personal contact. Women were recruited by random sampling from antenatal clinics when scheduling visits over the course of 5 weeks from December 2012 to February 2013 and were followed-up 1 month after birth. Of the 2199 women recruited, 99.63% were eligible for the study. RESULTS: Of the 748 women who expressed a desire to deliver their babies by cesarean section (CS) in early pregnancy, 87% had an elective cesarean section. The logistic regression analyses showed that normative beliefs (odds ratio [OR] 1.792, 95% confidence interval (1) 1.073-2.993), control beliefs (OR: 0.272, 95% CI: 0.162-0.459), and evaluation of outcomes (OR: 0.431, 95% CI: 0.268-0.692) favored the preference for cesarean section. The desire for delivery by elective cesarean section was associated with normative beliefs (OR: 1.138; 95% CI: 1.001-1.294), control beliefs (OR: 0.804; 95% CI: 0.698-0.927), and expectations about maternity care (OR: 0.772; 95% CI: 0.683-0.873), medical influences (OR: 1.150; 95% CI: 1.023-1.291), evaluation of outcome (OR: 0.789; 95% CI: 0.696-0.894), age, preference for cesarean section (OR: 5.445; 95% CI: 3.928-7.546), spouse educational level, and number of live births. CONCLUSIONS: A woman's preference for delivery by cesarean section influenced their subsequent mode of delivery. Asking women in early pregnancy about their preferred mode of delivery provides the opportunity to extend their supports which might reduce the rate of elective cesarean section. This decision is affected by age, spouse educational level, number of live births, and preconceived maternal attitudes about delivery.

Multiple Imputation to Correct for Nonresponse Bias: Application in Non-communicable Disease Risk Factors Survey.

BACKGROUND: This study was carried out to use multiple imputation (MI) in order to correct for the potential nonresponse bias in measurements related to variable fasting blood glucose (FBS) in non-communicable disease risk factors survey conducted in Iran in 2007. METHODS: Five multiple imputation methods as bootstrap expectation maximization, multivariate normal regression, univariate linear regression, MI by chained equation, and predictive mean matching were applied to impute variable fasting blood sugar. To make FBS consistent with normality assumption natural logarithm (Ln) and Box-Cox (BC) transformations were used prior to imputation. Measurements from which we intended to remove nonresponse bias included mean of FBS and percentage of those with high FBS. RESULTS: For mean of FBS results didn't considerably change after applying MI methods. Regarding the prevalence of high blood sugar all methods on original scale tended to increase the estimates except for predictive mean matching that along with all methods on BC or Ln transformed data didn't change the results. CONCLUSIONS: FBS-related measurements didn't change after applying different MI methods. It seems that nonresponse bias was not an important challenge regarding these measurements. However use of MI methods resulted in more efficient estimations. Further studies are encouraged on accuracy of MI methods in these settings.

Analysis of survival data in thalassemia patients in Shiraz, Iran.

OBJECTIVES: The survival rate of thalassemia patients has not been conclusively established, and the factors associated with survival remain unclear. This study aimed to determine the survival rate of thalassemia among patients in southern Iran and to identify the factors associated with mortality from thalassemia. METHODS: This retrospective cohort study was conducted based on a retrospective review of the medical records of 911 beta-thalassemia patients in 2014. Data analysis was conducted using the Kaplan-Meier method and Cox regression analysis. RESULTS: Overall, 212 patients (23.3%) died, and 26.8% had thalassemia intermedia. The 20-year, 40-year, and 60-year survival rates were 85%, 63%, and 54%, respectively. Both crude and adjusted analyses found that education, marital status, ferritin levels, and comorbidities were related to mortality. CONCLUSIONS: Sociodemographic and hematological factors were found to be significantly associated with the survival rate of thalassemia. Addressing these factors may help healthcare providers and physicians to provide the best possible care and to improve the survival rate.

Risk factors for C-section delivery and population attributable risk for C-section risk factors in Southwest of Iran: a prospective cohort study.

BACKGROUND: Iran has a high C-section rate (40.6% in 2005). The objective of this study was to assess the associations and population-attributable risks (PAR) of risk factors combinations and Csection in the Southwest Iran. METHODS: We performed a population-based cohort study using the reports provided by Shiraz University of Medical Sciences. The cohort included pregnant women within September 2012 and February 2013 (n=4229), with follow-up until delivery. Then, the actual delivery was recorded; i.e., C-section delivery, vaginal delivery, and miscarriage. A multiple logistic regression model was used to estimate the point and the interval probability. The adjusted population attributable risks (aPARs) were calculated through adjusted odds ratio from the final multiple logistic regression models for each variable. RESULTS: Of 4,217 deliveries, 2,624 ones were C-section (62.2%). The rate of C-section was significantly higher in healthcare departments of private clinics compared to governmental clinics. The rate increased steadily with the mother's age, marriage age, family income and education. The multiple logistic regression analysis showed that local healthcare, supplementary insurance, maternal age, age of marriage, place of birth, family income, maternal education, education of husband and occupation were the key contributing factors to choose the mode of delivery. The multiple logistic regression analysis for reproductive factors showed that parity, previous abortion and stillbirth, previous infertility, birth weight (g) and number of live births were selected risk factors for C-section. Among the exposures, family income, location of healthcare and place of birth showed the highest population attributable risks: 43.86%, 19.2% and 18.53%; respectively. CONCLUSION: In this survey, a relatively large contribution of non-medical factors was identified against the background of C-section. All of these factors influence the knowledge, attitudes and norms of the society. Thus, the attention of policymakers should be drawn to the factors associated with this mode of delivery.

Ten-year Survival and Its Associated Factors in the Patients Undergoing Pacemaker Implantation in Hospitals Affiliated to Shiraz University of Medical Sciences During 2002 - 2012.

BACKGROUND: Heart failure is a prevalent disease affecting about 4.9 million people in the U.S. and more than 22 million individuals worldwide. Using electric pacemaker is the most common treatment for the patients with heart conduction problems. The present study aimed to determine the factors affecting survival in the patients undergoing pacemaker implantation in the hospitals affiliated to Shiraz University of Medical Sciences. OBJECTIVES: The aim of the present study was to identify the factors affecting the survival of the patients suffering from arrhythmia. PATIENTS AND METHODS: This retrospective survival analysis was conducted on all 1207 patients with heart failure who had undergone permanent pacemaker implantation in the hospitals affiliated to Shiraz University of Medical Sciences from 2002 to 2012. The data were analyzed using non-parametric methods such as Kaplan-Meier method, life table, and Cox regression model. The risk factors of mortality were determined using multivariate Cox proportional hazards method. RESULTS: Survival data were available for 1030 (80%) patients (median age = 71 years [5th to 95th percentile range: 26 - 86 years]) and follow-up was completed for 84.28% of them. According to the results, 56% of the patients had received dual-chamber systems, while 44% had been implanted by single-chamber ventricular systems. Moreover, sick sinus syndrome and pacemaker mode were independent predictors of increased mortality. CONCLUSIONS: In this study, sick sinus syndrome and pacemaker mode followed by syncope were independently associated with increased mortality.

Pathological profile of patients with breast diseases in Shiraz.

BACKGROUND: Around 200,000 breast disorders are annually diagnosed all over the world. Fibrocystic changes are the most common breast disorder and fibroadenoma is the most prevalent benign breast tumor. The present study aimed to determine the spectrum, type and prevalence of breast masses in women referred to Shiraz University of Medical Sciences between 2004 and 2012 . MATERIALS AND METHODS: A cross-sectional study was conducted on the diagnostic reports data. RESULTS: A total of 640 samples were studied. Most 57.3% of masses were detected in the left breast, 65%, 28.2% and 6.1% of cases presenting with benign, malignant, and inflammatory lesions, respectively. Among all the samples the most prevalent diagnosis (37.7%) was fibroadenoma and fibrocystic lesions (17%). 174 samples (96% of the malignant cases) were invasive. 6.5% of the benign, and 37% of the malignant cases occurred in post menopause women and the differences were statistically significant. Among those with malignant tumors lymph nodes were involved in 25.6% of menopausal women and 44.2% of non-menopausal ones, and the difference was statistically significant. CONCLUSIONS: Regular clinical breast examination beside mammographic follow-ups, especially during menopause, should be carried out as a priority and a national organized program should be designed for screening breast disorders.

Breast cancer risk factors in women participating in a breast screening program: a study on 11,850 Iranian females.

The incidence rate of breast cancer in developed countries is almost three-fold higher than in developing countries. Iran has had one of the lowest incidence rates for breast cancer in the world, but during the recent decades a marked increase has been seen. The purpose of this study was to investigate some established risk factors of breast cancer in Iranian women. A study of 11,850 women participating in abreast screening program was conducted. The 197 women diagnosed with breast cancer and 11,653 healthy women were compared. Logistic regression was performed to investigate associations of reproductive and anthropometric factors with breast cancer risk. Family history of breast cancer (OR=1.94 , 95%CI=1.35-2.78), occupation (OR= 1.65,95%CI=1.20- 2.25), education level (OR=0.50,95%CI=0.28-0.91), parity (OR=0.27, 95%CI=0.12-0.59), menopausal status (OR=3.15, 95%CI=2.35-4.21), age at menarche (OR=0.33, 95%CI=0.15-0.70), and age at the first pregnancy (OR=4.10 , 95%CI=1.13-14.77) were related to the risk of breast cancer. Decrease in parity may to some extent explain the rising trend of incidence of breast cancer incidence in Iranian women.

Determinants of inequity in health care services utilization in markazi province of iran.

BACKGROUND: National and international statistics from Iran have indicated that progresses and achievements have been made for most health indicators, but there are differences in some indicators in special groups and at the provincial level. OBJECTIVES: Our aim was to assess the main predictors of inequity in seeking Health Care Utilities (HCU) locally. PATIENTS AND METHODS: Data gathered from the HCU survey, which was conducted in the Markazi province of Iran during 2008, was used in the present study. A systematic sampling method, based on the Iranian household framework, was applied in order to choose 758 households as well as 2711 individuals. The household wealth index constructed by Principle Component Analysis (PCA) and robust login link function in Generalized Estimation Equation (GEE) model were used in order to determine the predictors of inequity. RESULTS: 66.4% of those in need sought outpatient health care from which 97.7% received appropriate services. After adjustment for the clustering effect of household as well as confounding effect of the covariates, GEE model showed that there were inequities in HCU for females (OR = 2.44, CI; 1.24- 4.81) and subjects with inpatient need (OR = 2.14, CI: 1.23-3.72). Being in the lowest quintile of household wealth index was associated with the lower use of outpatient health services (OR = 0.45, CI; 0.23- 0.88). CONCLUSIONS: In spite of improvements in the national health indicator, different groups of people use health care services differently, but these inequities in HCU are related to social and individual factors. Also, it is clear that health sector facilities and the accessibility to health services are not the only predictors.

The Effect of Cochlear Implantation on the Improvement of the Auditory Performance in 2-7 Years old Children, Shiraz 2004-2008.

BACKGROUND: Hearing loss is the most common sensorineural deficiency in human beings. Cochlear implantation is introduced worldwide to treat the severe to profound sensorineural hearing loss, and can result in both speech comprehension and production. OBJECTIVES: The present study aims to determine the effect of cochlear implantation on the improvement of the auditory performance in 2-7 years old children. PATIENTS AND METHODS: The present follow-up study is a kind of cohort study which was conducted on 98 children between 2-7 years old who had referred to Fars Cochlear Implantation Center. The patients' information was gathered from their profiles both before and after the operation. The auditory performance score was obtained in 3 stages; 6 months, 1 year, and 2 years after the cochlear implantation through the Cap test. The data was analyzed using the nonparametric Friedman test as well as Mann-Withney, Kruskal-Wallis, and Spearman's Ranks Correlation coefficients. RESULTS: The mean and the median of the auditory performance score of the children who had undergone the cochlear implantation revealed a significant improvement from 6 months to 1 year, and 2 years after the implantation. It showed a significant statistical association between implantation age, type of hearing loss, regular reference, and the length of being present in the rehabilitation program with the auditory performance. It showed no significant association between sex, mother's level of education, being monolingual or bilingual, and family size with the auditory performance. CONCLUSIONS: This study revealed that the type of hearing loss, Presence in the rehabilitation program, and the age of cochlear implantation can be major prognostic factors of the response to the treatment, then the country's health policy makers and health planners must executively take into account the infants' hearing screening program during the first 6 month of age.

Hepatitis C Virus Infection in HIV Positive Attendees of Shiraz Behavioral Diseases Consultation Center in Southern Iran.

OBJECTIVE: To determine the prevalence of HCV co-infection and its correlation with demographic and risk factors among human immunodeficiency virus (HIV)-infected individuals attending Shiraz behavioral diseases consultation (SBDC) Center in southern Iran. MATERIALS AND METHODS: In a cross-sectional study, 226 consecutive HIV-positive patients who referred to SBDC Center from April 2006 to March 2007 were interviewed face-to-face to record demographic data and risk factors of HIV transmission. A 10ml sample of venous blood was drawn from every subject and tested for HCV-antibodies by third generation enzyme linked immunosorbant (ELISA) and recombinant immunoblot assays (RIBA). All samples were also analyzed by qualitative reverse transcriptase polymerase chain reaction (RT-PCR) for detection of HCV-RNA. RESULTS: The study population consisted of 214 men (94.7%) and 12 women (5.3%) with a mean age of 35.6 ± 7.9 years. The most prevalent risk factor was imprisonment (88.9%) followed by injecting drug use (79.2%). The prevalence of HCV infection was 88.5% by ELISA and 86.7% by RIBA, while HCV viremia was detected in 26.1% of the patients. HCV-antibody positivity was significantly associated with gender, age, marital status, occupation, injecting drug use, and history of imprisonment. It was inversely related to having an infected or high risk sexual partner. In the logistic regression model, the predictors of HCV-positivity were injecting drug use (OR = 24.9, P = 0.004) and imprisonment (OR = 21.4, P < 0.001). CONCLUSIONS: Prevalence of HCV infection among HIV-positive individuals in our region is very high and there is a need for stricter preventive actions against transmission of HCV among this group of patients.

The effect of learning via module versus lecture teaching methods on the knowledge and practice of oncology nurses about safety standards with cytotoxic drugs in Shiraz University of Medical Sciences.

BACKGROUND: Several studies have established that all nurses need continuing education, especially those who are working in oncology wards. In the current programs, there are just two general patterns for teaching: Teacher-centered and student-centered patterns. In this study, the effect of teacher-centered (lecture) and student-centered (module) teaching methods in relation to safety standards with cytotoxic drugs on the knowledge and practice of oncology nurses was compared. MATERIALS AND METHODS: This research was a quasi-experimental study with two intervention groups (module and lecture) and a control group. In this study, 86 nurses in Shiraz, Fars province in 2011, who participated in the prescription of cytotoxic drugs to patients were selected and randomly divided into three groups. The module group used a self-directed module, the lecture group was taught by an experienced lecturer in the classroom and the control group did not receive any intervention. Data in relation to knowledge and practice of oncology nurses in the three groups were collected before and 8 weeks after the intervention by using a questionnaire and checklist. To analyze the data paired-samples t-test and one way ANOVA analysis were used. RESULTS: Knowledge and practice scores increased significantly from baseline in both intervention groups, but there was no significant difference between the scores of the two groups. No considerable changes were observed in the control group. CONCLUSIONS: Both module and lecture methods have similar effects on improving the knowledge and practice of nurses in oncology wards. Therefore, considering the advantages of student-centered educational methods, the work load of nurses and the sensitivity of their jobs, we suggest using module.

Ten-year graft survival of deceased-donor kidney transplantation: a single-center experience.

BACKGROUND: Kidney transplantation is the treatment of choice for end-stage renal disease that restores the patients' quality of life and reduces the morbidity and mortality rates induced by renal failure and its complications. However, after transplantation the organ and patient survival rates are important issues of interest in many centers worldwide. SUBJECTS AND METHODS: This is a historical cohort study planned to determine the organ survival rate after kidney transplantation from deceased donor during a period of 10 years (March 1999-March 2009) in Shiraz Transplant Center, Namazi Hospital, Shiraz, Iran. We tried to clarify the probable contributory risk factors implicating in graft loss. Kaplan-Meier method was used to determine the survival rate. Log-rank test was used to compare survival curves, and Cox regression model to define the hazard ratio and for modeling of factors implicating in survival rate. RESULTS: Mean follow-up period was 37.54 +/- 28.6 months. Allograft survival rates at 1, 3, 5, and 9 years after kidney transplantation from deceased donor (calculated by Kaplan-Meier method) was found to be 93.7, 89.1, 82.1, and 80.1%, respectively. Duration of dialysis before operation and creatinine level at discharge were showed to be the most important factors influencing survival rate of renal allograft. CONCLUSION: Overall long-term graft survival in our cohort is satisfactory and comparable with reports from large centers in the world. Duration of dialysis before operation and creatinine level at discharge are the only independent factors that could correlate with long-term graft survival in our cohort.

Association between perceived demands and musculoskeletal disorders among hospital nurses of Shiraz University of Medical Sciences: a questionnaire survey.

Excessive demands on nurses may result in high rates of musculoskeletal disorders (MSDs). This study was conducted among hospital nurses of Iran's Shiraz University of Medical Sciences (SUMS) to determine the prevalence of MSDs and to examine the relationship between perceived demands and reported MSDs. In this study, 641 randomly selected nurses from 12 SUMS hospitals participated. The Nordic musculoskeletal disorders questionnaire and Job Content Questionnaire were used as collecting data tools. The results showed that 84.4% of the participants had experienced some form of symptoms of MSDs during the past 12 months. Lower back symptoms were found to be the most prevalent problem. Perceived physical demands were significantly associated with MSDs (OR = 1.5-2.7). No association was found between perceived psychological demands and reported symptoms. It was concluded that any intervention program for preventing MSDs among SUMS hospital nurses had to focus on reducing physical demands, particularly excessive postural demands.

Hysteroscopic metroplasty of the complete uterine septum, duplicate cervix, and vaginal septum.

OBJECTIVE: To determine if sectioning of the cervical septum in hysteroscopic metroplasty of the complete uterine septum is associated with intraoperative bleeding, cervical incompetence, and secondary infertility. DESIGN: Multicenter, randomized, controlled clinical trial. SETTING: University hospitals. PATIENT(S): Twenty-eight women with a diagnosis of complete uterine septum who had a history of pregnancy wastage or infertility. They were randomized into two groups: group A underwent metroplasty including section of the cervical septum; group B underwent the same procedure with preservation of the cervical septum. INTERVENTION(S): Hysteroscopic metroplasty was performed for all patients in the two groups. MAIN OUTCOME MEASURE(S): Operating time, distending media deficit, total distending media used, intraoperative bleeding, complications, and reproductive outcome. RESULT(S): Operating times were 36.40 +/- 10.67 minutes and 73 +/- 14.40 minutes in group A and group B, respectively. Distending media deficit was 456.66 +/- 165.68 mL in group A, while in group B it was 673.84 +/- 220.36. Two cases of pulmonary edema and three cases of significant bleeding (> 150 mL) were seen in group B. The cesarean section rate was significantly higher in group B. There were no significant differences in the reproductive outcome in the two groups. CONCLUSION(S): Resection of the cervical septum during hysteroscopic metroplasty of complete uterine septum makes the procedure safer, easier, and less complicated than the procedure with preservation of the cervical septum. This procedure is recommended for all cases of complete uterine septum.