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.

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.

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.

Prognostic Factors Associated with Curing in Patients with Breast Cancer: A Joint Frailty Model.

BACKGROUND: Recurrent event data arise frequently in longitudinal medical studies. In many situations, there are a large portion of patients without any recurrences, manifesting the "zero-inflated" nature of the data. Moreover, there often exists a terminal event which may be correlated with the recurrent events. The goal of this study is to extend the application of joint frailty model to identify the prognostic factors associated with curing in patients with breast cancer. METHODS: As a prospective study, medical records of women who had been attended to Cancer Research Center, Shahid Beheshti University of Medical Sciences from January 1998 to February 2016 were reviewed. Finally, after an initial review of medical records, 711 patients were included in the study and analyzed. A checklist that included items drawn from the demographic background of patients was provided in the study. Two joint frailty models for zero-inflated recurrent events, combining a logistic model for "structural zero" status (Yes/No) and a joint frailty proportional hazards model for recurrent and terminal event times were performed to identify factors associated with BCS. RESULTS: The mean age of patients was 38.2 years. The numbers of subjects with 1, 2, 3, and 4 recurrent events were 392, 207, 97, and 15, respectively. The median follow-up time was 6.87 years. There were 137 (19.2%) deaths from cancer during the follow-up. Among the 574 patients who were censored, 418 had no tumor recurrence. Thus, there may exist a large portion of "cured" subjects. We can see that the radiation (OR = 6.02, CI = (3.87, 8.61)) and tumor size interaction with radiation (OR = 1.065, CI = (1.002-1.26)) were significant in the cure model (P < 0.05) which means that patients with smaller tumor sizes were more likely to be cured by radiation therapy. CONCLUSIONS: Our proposed models can help investigators to evaluate which treatment will result in a higher fraction of cured subjects. This is usually an important research question in biomedical studies.

Identification of factors that influence occupational accidents in the petroleum industry: A qualitative approach.

BACKGROUND: Exploring experiences of individuals for barriers they confront relating to safety could help to design safety interventions with an emphasis on the most safety influencing factors. OBJECTIVE: This study strived to present an empirical exploration of individuals' experiences across the petroleum industry at different levels of the organizational structure for factors that influence occupational accidents. METHOD: Based on accidents history, face-to-face semi-structured interviews were conducted with individuals who engaged in fatal activities, as well as authorities responsible for managing safety. The qualitative content analysis of 46 interview transcripts was conducted using MAXQDA software. RESULTS: A three-layer model comprising organizational, supervisory and operator level influencing factors with 16 categories were found influence factors of occupational safety. The results highlighted the role of organizational factors, including inappropriate contract management, inadequate procedures, and issues relating to competency management and the organizational climate. Moreover, defects relating to the monitoring and supervision system were identified as important causes of accidents. CONCLUSIONS: The findings demonstrated that the qualitative approach could reveal additional latent aspects of safety influencing factors, which require consideration for the appropriate management of occupational safety. This study can guide the planning of preventive strategies for occupational accidents in the petroleum industry.

Multistate Models to Predict Development of Late Complications of Type 2 Diabetes in an Open Cohort Study.

BACKGROUND: Increase in the prevalence of type 2 diabetic mellitus (T2DM) as a complex disease, its complications, and spread has become a dominant global health threat in recent decades. OBJECTIVE: The aim of the current study was to investigate the impact of risk factors and transition probability on the development and progression of the late complications of T2DM. METHODS: This study was an open cohort one which was conducted at Isfahan Endocrine and Metabolism Research Center (IEMRC). The data were collected from 1993 to 2018. The sample size consisted of 2519 adults diagnosed with type 2 diabetes. We applied the homogeneous multistate models including no complication, retinopathy alone, coronary artery disease (CAD), microalbuminuria, retinopathy and CAD, and the final absorbing mortality states. RESULTS: Based on our results, time-varying hypertension strongly intensified the hazard of transition to mortality in CAD, no complication, CAD and retinopathy, and retinopathy patients by 4.99, 4.09, 3.42, and 2.65 times, respectively. Hypertension seemed to be a potential factor for the transition of microalbuminuria to no complication in diabetic patients. One-unit increase in LDL increased the hazard ratio of transition from CAD, and retinopathy and CAD to mortality by 1.8% and 2.4%, respectively. Moreover, one level increase in time-varying HbA1c increased the hazard ratio of transition to retinopathy and mortality among no complication diabetic patients by 30% and 67%, respectively. One level increase in time-varying HbA1c also intensified the hazard ratio of transition from retinopathy to mortality by 45%. The same level of increase in time-varying HbA1c also intensified the hazard ratio of transition from CAD alone to CAD and retinopathy, and microalbuminuria to retinopathy by 26% and 50%, respectively. CONCLUSION: In addition to glycemic control, our study indicates that controlling hypertension and hyperlipidemia is more effective in reducing mortality and the diabetic macro- and microvascular complications.

Factors affecting unsafe behavior in construction projects: development and validation of a new questionnaire.

Introduction. Occupational safety in general, and construction safety in particular, is a complex phenomenon. This study was designed to develop a new valid measure to evaluate factors affecting unsafe behavior in the construction industry. Methods. A new questionnaire was generated from qualitative research according to the principles of grounded theory. Key measurement properties (face validity, content validity, construct validity, reliability and discriminative validity) were examined using qualitative and quantitative approaches. The receiver operating characteristic curve was used to estimate the discriminating power and the optimal cutoff score. Results. Construct validity revealed an interpretable 12-factor structure which explained 61.87% of variance. Good internal consistency (Cronbach's α = 0.94) and stability (intra-class correlation coefficient = 0.93) were found for the new instrument. The area under the curve, sensitivity and specificity were 0.80, 0.80 and 0.75, respectively. The new instrument also discriminated safety performance among the construction sites with different workers' accident histories (F = 6.40, p < 0.05). Conclusion. The new instrument appears to be a valid, reliable and sensitive instrument that will contribute to investigating the root causes of workers' unsafe behaviors, thus promoting safety performance in the construction industry.

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.

Prognostic factors associated with locoronal relapses, metastatic relapses, and death among women with breast cancer. Population-based cohort study.

BACKGROUND: This study was designed to identify the prognostic factors associated with two types of relapses of breast neoplasms. The aim of this study was to evaluate the association between two possible relapses for the increased incidence of distant metastases observed in patients with local relapses injuries, using multivariate statistical models. DESIGN: And Setting: A population-based cohort study that was designed as a single center: the cancer research center, Shahid Beheshti University of medical sciences. METHODS: This study was conducted on 1815 patients with breast cancer having age of 22 or more. This study considers the analysis of recurrence and survival by joint modeling of three correlated outcomes: local recurrence, distant recurrence (metastasis) and death. The goals are to find out the effects of treatments on recurrences and death, the effects of relapses on death and the correlation between local and distant recurrences. RESULTS: According to obtained results of the fitted models, the risk of local and metastatic relapses or death increased for patients with at least one positive lymph node (N+) or for patients with a grade greater than I. Also, the variable HR+ was significantly associated with the hazards of locoronal, metastatic recurrence and the death for both reduced and proposed models (P < 0.05). CONCLUSIONS: We concluded that if the association between these outcomes are not taken into account, we may lose important information. Given the small number of recurrent events, these results should be considered with caution.

Exploring the Contributory Factors of Confined Space Accidents Using Accident Investigation Reports and Semistructured Interviews.

BACKGROUND: The oil and gas industry is one of the riskiest industries for confined space injuries. This study aimed to understand an overall picture of the causal factors of confined space accidents through analyzing accident reports and the use of a qualitative approach. METHODS: Twenty-one fatal occupational accidents were analyzed according to the Human Factors Analysis and Classification System approach. Furthermore, thirty-three semistructured interviews were conducted with employees in different roles to capture their experiences regarding the contributory factors. The content analyses of the interview transcripts were conducted using MAXQDA software. RESULTS: Based on accident reports, the largest proportions of causal factors (77%) were attributed to the organizational and supervisory levels, with the predominant influence of the organizational process. We identified 25 contributory factors in confined space accidents that were causal factors outside of the original Human Factors Analysis and Classification System framework. Therefore, modifications were made to deal with factors outside the organization and newly explored causal factors at the organizational level. External Influences as the fifth level considered contributory factors beyond the organization including Laws, Regulations and Standards, Government Policies, Political Influences, and Economic Status categories. Moreover, Contracting/Contract Management and Emergency Management were two extra categories identified at the organizational level. CONCLUSIONS: Preventing confined space accidents requires addressing issues from the organizational to operator level and external influences beyond the organization. The recommended modifications provide a basis for accident investigation and risk analysis, which may be applicable across a broad range of industries and accident types.

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.

Clinicopathological features and survival of colorectal cancer patients younger than 50 years: a retrospective comparative study.

BACKGROUND: Colorectal cancer (CRC) is a disease of old age, but its incidence has been rising among younger population compared to older ones. Nevertheless, there is a controversy over survival of younger patients compared to the older ones. Therefore, in the current study, we investigated the clinicopathological features and survival of the younger (< 50 years) versus older (≥ 50 years) CRC patients. RESULTS: The younger and older groups consisted of 39.4% and 60.6% of patients, respectively. Both age groups were comparable regarding the symptom presentation and duration, and pre-operative carcinoembryonic antigen (CEA). The younger patients were diagnosed with a higher proportion of poorly differentiated (14.7% vs. 8.3%; p < 0.001) and more advanced tumors (53.2% vs. 45.9%; p = 0.266). The rectum tumor site was significantly more common among the younger patients (p = 0.021). The overall survival (OS) (p = 0.278), the cancer-specific survival (CSS) (p = 0.233), and the disease-free survival (DFS) (p = 0.497) did not differ significantly between the two groups. Based on Cox regression model, elevated pre-operative CEA level (HR = 1.41; 95%CI of 1.01-1.97), advanced tumor stage (6.06; 95%CI of 3.03-12.15), and poorly differentiated tumor (HR = 1.69; 95%CI of 1.05-2.71) were associated with decreased survival. CONCLUSIONS: The younger patients did not have poor prognosis compared to the older ones despite having an advanced tumor stage and a poor tumor differentiation.

A qualitative investigation of factors influencing unsafe work behaviors on construction projects.

BACKGROUND: Unsafe behavior is an important component in the chain of accident occurrences, and thus plays a key role in the accident prevention programs in construction sites. OBJECTIVE: The aim of this qualitative research is to study the perception of frontline workers, supervisors, and managers about the preconditions of and contributing factors to unsafe behaviors in civil engineering projects. METHODS: Field observation, in-depth interview, and focus group discussion are conducted with 113 informants from various mega projects during a 2-year time period. Fishbone diagram is applied to describe a conceptual model. RESULTS: The results point to fourteen themes within four categories of the conceptual model - general management, organizational factors, safety supervision and management, and individual characteristics. CONCLUSIONS: General management and organizational culture were introduced as important preconditions and contributing factors resulting in human error and unsafe behavior in the construction sites. The fishbone diagram reveals the sequence and interaction of preconditions and contributing factors. The key contributing factors and their influences on unsafe behaviors are discussed along with recommendations for future directions.

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.

The Meaning of Managerial Competency of ICU Head Nurses in Iran: A Phenomenological Study.

BACKGROUND: The health system in Iran faces specific challenges as the managerial role of head nurses have changed. The importance of this role cannot be underestimated for the healthcare organizations' success. The present study was conducted to explore the meaning of managerial competence of head nurses in intensive care units (ICU) in Iran. MATERIALS AND METHODS: This study used a qualitative approach. We extracted the lived experience of ten Iranian ICU head nurses. Data were collected through unstructured in-depth interviews from 2014 to 2015. Interviews were recorded and transcribed verbatim and were interpreted using Van Manen's six-step approach. RESULTS: The expansion and clustering of 442 initial themes led to the emergence of 35 secondary themes, nine subthemes, and three main themes. Managerial competence - theme included "self-excellence," "ward excellence," and "intensive care excellence." CONCLUSIONS: The "managerial competence of ICU head nurses" is a dynamic concept that reflects the psychological and functional capability of head nurses in contributing towards excellence in their own critical care practice as well as that of the ward. A competent head nurse has outstanding personal and nursing attributes and holistic knowledge, and is also committed to the ongoing professional improvement of him/herself. Using their ability to facilitate interpersonal and interprofessional communication effectively, a head nurse seeks the psychological, physical, and human optimization of the ward in which he/she works. Therefore, the goal of providing insightful critical care through smart organization and planning of nurses and other personnel can be achieved.

Effective Factors on the Rate of Growth Failure in Children below Two Years of Age: A Recurrent Events Model.

BACKGROUND: Growth failure, constituting one the health problems in children below 2 yr of age, can lead to major complications such as death or mental, emotional and physical disabilities. The present study aimed to investigate effective factors on growth failure in the height and weight of less than 2 yr old children of Khorramabad, Iran in 2013. METHODS: This present longitudinal retrospective study used stratified and clustered sampling. Based on growth curves in family records, the incidence times of growth failure in height and weight of each child were recorded. In the next stage, using recurrent events model (proportional rate model), along with SAS software (version 9.2), the data were modeled. RESULTS: According to proportional rate model, the effect of mothers' educational level on the rate of growth failure in the height and weight of children was significant (P=0.046, P=0.049) and the effect of fathers' job was significant only on growth failure in children's weight (P<0.001). However, the effect of other variables, including gender, birth order and exclusive breastfeeding status on children's growth failure rate was not significant. CONCLUSION: Enhancing mother's awareness in low-income families, in tandem with changing educated mothers' attitude towards the required skills and guiding principles for feeding children below 2 yr of age, can be conceived of as the most important approach in dealing with growth failure of children.

Modeling In Vitro Fertilization Data Considering Multiple Outcomes Observed among Iranian Infertile Women.

BACKGROUND: Women undergoing in vitro fertilization (IVF) cycles should successfully go through multiple points during the procedure (i.e., implantation, clinical pregnancy, no spontaneous abortion and delivery) to achieve live births. In this study, data from multiple cycles and multiple points during the IVF cycle are collected for each individual to model the effects of factors associated with success at different stages of IVF cycles in Iranian infertile women. MATERIALS AND METHODS: This historical cohort study includes 996 assisted reproductive technology (ART) cycles of 511 infertile women. Covariates considered in this study were women's age, type of cycle (fresh or frozen embryo transfer), number of embryos transferred and having polycystic ovarian syndrome during IVF cycles. Generalized estimating equations were used for calculation of odds ratio (OR) and 95% confidence intervals (95% CI) of success at different stages during IVF cycles. Cluster-weighted generalized estimating equations (CWGEE) was also fitted to handle informative cluster size. RESULTS: After adjusting for potential confounders, it was seen that receiving frozen embryo transfer was associated with higher odds of success compared to receiving fresh embryo transfer (adj OR: 2.26, 95% CI: 1.66-3.07); however, cycles with fresh embryo transfer exhibited better results in clinical pregnancy compared to those receiving frozen embryo. Being in the age category of 38 to 40 was associated with lower odds of success compared to the reference category (p<35) in CWGEE model (adj OR: 0.67, 95% CI: 0.45-1.00). The number of embryos transferred was positively associated with the odds of success in CWGEE (adj OR: 1.21, 95% CI: 1.03-1.42) as well as the GEE model. CONCLUSION: Receiving frozen embryo was positively associated with odds of success compared to cycles with fresh embryo. The number of embryos transferred and women's age were significantly associated with odds of success.

Association between Multiple Recurrent Events with Multivariate Modeling: A Retrospective Cohort Study.

BACKGROUND: Recurrent event data are often encountered in biomedical research, for example, recurrent infections or recurrent hospitalizations for patients after renal transplant. In many studies, there are more than one type of events of interest. We aimed to identify the association between two types of events using multivariate joint modeling and then apply this statistical method in the clinical data set. STUDY DESIGN: A retrospective cohort study. METHODS: Overall, 342 subjects with breast cancer whose records were registered for follow-up in a Cancer Research Center at Shohadaye Tajrish Hospital, Tehran, Iran from 2006 to 2015 were investigated. These patients were monitored for at least 6 months after diagnosis and their latest status were recorded. Joint frailty model was used for modeling the relationship between two types of recurrences with Frailty package in R software. RESULTS: When the terminal event was considered as death, three-year and five-year survival rates for the patients were 0.79 and 0.68, respectively. Given the results obtained from a fitted joint frailty model, the risk of multiple recurrences (local and metastases) increased for the patients with tumor grades greater than I. CONCLUSION: With regard to the significant variance of the frailty component of the metastases event, it can be inferred that patients with the same predictive variables are prone to different levels of metastases risk and, on the other hand, given the low frequency of types of recurrences, caution should be exercised when considering the obtained results.

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.

Barriers to Pap Smear Test for the Second Time in Women Referring to Health Care Centers in the South of Tehran: A Qualitative Approach.

BACKGROUND: Cervical cancer is a preventable disease with a regular screening program. Many studies have reported a large number of barriers that women had for the first time, but this study decided to find other barriers for the second time pap smear. METHODS: In this qualitative research, data were gathered through in-depth interviews and expressed through conventional content analysis in the form of constant comparison. The participants were 15 women with family profile at 30 health care centers who lived in the south of Tehran and had done Pap smear for one time but didn't do it for the second time. RESULTS: Three main themes emerged from the analysis of the interviews: negative experiences of the first Pap test were as follows: results of the first time test, readiness for performing the test, getting the test itself, and the site of the first Pap test. Personal barriers to getting the second Pap test were: inattention to time, physical barriers to the second Pap test, and inhibitory beliefs. Perceived social barriers to getting the second Pap test with two sub-themes included social supports and abstract norms. CONCLUSION: This study provided other barriers about Pap smear including lack of the spouse's support, the role of health care providers and physicians in screening program for early diagnosis in women.