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Background: Bronchiolitis obliterans syndrome (BOS) is delayed allograft deterioration after lung transplant (LTX) that is clinically characterized by ≥ 20% decline from the baseline value of forced expiratory volume during the first second (FEV1). BOS is still a major obstacle limiting long-term survival post-LTX. The main aim of this study was to determine the predictors of BOS and death in Iranian LTX recipients. Materials and Methods: This retrospective cohort study included 44 LTX recipients who survived ≥ 3 months post-LTX at the Masih Daneshvari Hospital, Tehran, Iran from 2000 to 2014. The outcome was time from lung transplantation to BOS and/or death (due to all causes except BOS). We used competing risks analysis to assess the effect of other factors on the cumulative incidence function of BOS and death. We applied a Fine and Gray model with Bayesian approach. Results: The recipients’ age (Mean ± SD) was 36.7 ± 14.5 yr. 11 (25%) recipients developed BOS as the first event within the first five years post-LTX and 13 (30%) died due to all causes except for BOS. Our results showed that CMV infection was associated with a significant increase in risk of developing BOS [hazard ratio (HR) 1.22 (95% credible set: (1.01, 3.2)] controlling for other variables. Bilateral transplantation [HR (95% credible set): 2.4(1.51, 4.05)] and CMV infection [HR (95% credible set): 2.02 (1.67, 2.55)] were predictors of the mortality risk. Conclusion: CMV infection was a predictor of BOS risk in the studied patients. Moreover, bilateral transplantation and CMV infection were significant predictors of mortality in the present sample. Multi-center studies with larger sample sizes are required to better study the other risk factors, and the pathophysiologic mechanisms of BOS.

Background and Objectives : The aim of this study was to assess the disease trajectory and recurrence rate of pemphigus based on the analysis of the gap time between successive recurrent events. In this regard, the most important associated factors with the risk of recurrence could be explained. Methods: This longitudinal study was performed on 112 pemphigus patients who attended the dermatology department of Imam Khomeini Hospital, Tehran, Iran, from March 2006 to January 2013. The study duration was considered from the diagnosis of the disease to December 2013. Recurrent events were analyzed based on the gap time between successive events using the multivariate time dependent frailty model. The time between two recurrent gap times was determined monthly between two successive events. Results : Decreasing the gap times between two successive events indicates that the subsequent event after the first recurrence occurs with shorter time intervals. So, the disease trajectory represents an increase in the recurrence rate over time. Based on the results of multivariate frailty model, IgG antibody's level was the only effective factor on the recurrence hazard rate of the patients. Also, this model proved that the frailty effects were time dependent frailties. Conclusion: Assessing the disease trajectory and recurrence hazard rate can be achieved through analyzing the gap time between successive recurrent events. This analysis also identifies the factors that influence the risk of subsequent recurrent events.

Background: Stigma is a serious impediment to the well being of those who experience it. Many family caregivers are challenged by the stereotypes and prejudice that result from misconceptions about bipolar disorder. Objective: The purpose of this study was to explore the stigma experienced by family caregivers of patients with bipolar disorder. Methods: This was a qualitative and phenomenological study. In this study we selected the family caregivers of patients with bipolar disorder in a psychiatric hospital (Iran) using purposive sampling in 2011. By reaching data saturation the number of participant was 12. Data were gathered through in depth interviews and analyzed by the "Collaizi" method . Result: Stigma was a pervasive concern to almost all participants. Family caregivers of patients with Bipolar disorders reported feelings and experiences of stigma and were most affected by them. Analysis of the interviews revealed 3 themes: Negative judgment Shame Stigmatization and Social Isolation. Conclusion: For a person with bipolar disorder this illness is associated with the following problems: worse recovery difficulty accessing health services receiving poor treatment and support and difficulty gaining community acceptance. Rejection of people with mental illness might also affect their family caregivers at various levels.

Surgical procedures performed using spinal anesthetic techniques present a special challenge to anesthesiologists, because patients are awake and are exposed to multiple anxiety provoking visual and auditory stimuli. Therefore, this study was carried out to define the effect of music on the level of cortisol, blood glucose and physiological variables in patients under spinal anesthesia. In this semi-experimental research, 90 men aging from 18-48 years with ASA (acetylsalicylic acid) class I, who underwent urological and abdominal surgery, were investigated. Patients were divided randomly into three groups of thirty subjects. Music group (headphone with music), Silence group (headphone without music) and the control group (without interference). The level of cortisol and blood sugar was measured half an hour before and after the operation. Moreover, the physiological indicators in each of these three groups were monitored and recorded from ten minutes before getting spinal anesthesia to ten minutes after the operation. The level of blood cortisol didn't have any increase in the music group after operation compared to the time before that. However, in the groups of silence and control this level had risen (p< 0.05). The level of blood glucose in music group had declined and in the other two groups it had increased. Our data showed that listening to music during surgery under regional anesthesia has effects on cortisol levels and some of the physiological variables. Therefore the researcher offers to be used music therapy as a complementary method in patients on the reduce anxiety., EXCLI Journal ; Vol. 11, 2012

The objective of this study was to compare the quality of maternity care in 2 types of government-run hospital in the town of Khorram Abad, Islamic Republic of Iran in 2009: a university-linked teaching and a social security organization non-teaching hospital. A sample of 264 women hospitalized in the delivery and postpartum wards was selected. Data collection was done using interviews with mothers and observation checklists based on Iranian government criteria. The quality of maternity care in the non-teaching hospital was higher than the teaching hospital in terms of facilities, processes of maternal and newborn care and outcomes (mother's satisfaction). In the teaching hospital, the quality of the physical space, the educational level and training of health care personnel and monitoring and evaluation of care quality needed improvement. In both hospitals, meeting women's expectations about the degree of privacy could lead to an increase in the quality of maternity services.

Background & Objectives: Changing the pattern of mortality gives important perspective of health determinants. The aim of this study is to detect location and time of mortality pattern change in country using statistical change point method during 1971-2009 Years. Methods: We assume for years before and after 0 k , t y has a Poisson distribution with means 0 l and 1 l , respectively. We used several methods for estimation change point in real data by assume Poisson model. Results: Using two simulated and real data analysis showed that the change point has been occurred in year 1993 and this confirmed by all methods.Conclusion: Our findings have shown that the change pattern of mortality trend in Iran is related to improvement of health indicators and decreasing mortality rate in Iran.

"nBackground: The aim of this study was to predict the survival rate of Iranian gastric cancer patients using the Cox proportional hazard and artificial neural network models as well as comparing the ability of these approaches in predicting the survival of these patients."nMethods: In this historical cohort study, the data gathered from 436 registered gastric cancer patients who have had surgery between 2002 and 2007 at the Taleghani Hospital (a referral center for gastrointestinal cancers), Tehran, Iran, to predict the survival time using Cox proportional hazard and artificial neural network techniques. "nResults: The estimated one-year, two-year, three-year, four-year and five-year survival rates of the patients were 77.9%, 53.1%, 40.8%, 32.0%, and 17.4%, respectively. The Cox regression analysis revealed that the age at diag-nosis, high-risk behaviors, extent of wall penetration, distant metastasis and tumor stage were significantly associated with the survival rate of the patients. The true prediction of neural network was 83.1%, and for Cox regression model, 75.0%."nConclusion: The present study shows that neural network model is a more powerful statistical tool in predicting the survival rate of the gastric cancer patients compared to Cox proportional hazard regression model. Therefore, this model recommended for the predicting the survival rate of these patients.

Background & objectives: Competing risk data is one of the multivarite survival data. Competing risk data can be modelled using copula function. In this study we propose a bayesian modelling approach of competing risk data using the copula function.Methods: We used the data from colorectal cancer registyrarty in Tehran. After constructing likelihood function using Clayton copula by choosing appropriate prior distribution for parameters, we obtained the posterior distribution of parameters using the Metropolis-Hastings algorithms and Slice sampling. Results: The results of univariate analysis showed that sex, histology of tumor, extent of wall penetration, lymph node metastasis, distant metastasis and pathological stage of tumor were significantly associated with colon cancer and sex, histology of tumor, lymph node metastasis, distant metastasis and pathological stage of tumor were were significantly related to rectal cancer. In the multivariate analysis, age at diagnosis, tumor grade and distant metastasis were significant prognostic factors for colon cancer and tumor grade and size of the tumor were significant prognostic factors of rectal cancer Conclusions: As we showed some variables may have different impacts on colon and rectum cancers, consequently, further studies are needed to be conducted considering risk factors of these cancers separately.

Introduction: Cox regression model is one of the statistical methods in survival analysis.Proportionality of hazard rate is an assumption of this model. In the recent decades, artificial neuralnetwork (ANN) model has increasingly used in survival prediction. This study aimed to predict thesurvival probability of Gastric cancer patients using Cox regression and ANN models.Materials and Methods: In this historical-cohort study, information of total of 436 gastric cancerpatients with adenocarcinomas pathology who underwent surgery at the Taleghani hospital of Tehranbetween 2002 and 2007 were included. Data were divided to training and testing (or validation) groups,randomly. The Cox regression model (semi-parametric model) and a three layer ANN model were usedfor analyzing of database. Furthermore, the area under receiver operating characteristic curve (AUROC)and classification accuracy were used to compare these models.Results: Prediction accuracy of ANN and Cox regression models were 81.51% and 72.60%,respectively. In addition, AUROC of ANN and Cox regression models were 0.826 and 0.754,respectively.Conclusions: ANN was better than Cox regression model in terms of AUROC and accuracy ofprediction. Therefore, ANN model is recommended for prediction of survival probability. These findingare very important in health research, particularly in allocation of medical resources for patients whopredicted as high-risks.

Introduction: Gastric cancer is one of the most common cancers in the world. The classical methodssuch as Cox regression and parametric models are used in most medical researches that their aims is thesurvival distribution survey, although the Bayes models have some advantages in compared with theclassical models. The present study was performed to analyze the survival rate of patients who had gastriccancer and were under treatment in the gastroenterology ward of Taleghani hospital, in Tehran usingBayes models. Weibull distribution was used for modeling in the study .Material and Methods: This study was a cohort study and performed in the gastroenterology ward ofTaleghani hospital by using gastric cancer patient's data from January 2003 to December 2007.178patients were enrolled to the study and their information was collected through telephone contacts. Thesurvival rate of patients were analyzed using Bayes Weibull models by considering variables such as ageof diagnosis, gender, tumor size, metastasis of other lymph. For determining of the risk factors on thesurvival of patients, was used Weibull model in the case that interval censoring. Data analysis was carriedout using Winbugs software and significant levels were considered 0.05 .Results: The results showed survival rate are dependent on the age of diagnosis and tumor size. Thosepatients who had early diagnosis, the rate of survival was greater. In addition, he patients who had smallertumor size, their survival rate was greater .Conclusion: Considering to classical models are based on normal approximation and applicable for bigsamples, Bayes methods are emphasized for small to medium samples. The results of this study showedthat the Bayesian Weibull model is a suitable model. This study also showed that age of diagnosis andtumor size of patients is important factors in regard to the survival rate of these patients. As a result, ifgastric cancer is diagnosed early, the relative risk of death would reduce.

Purpose: To estimate cure rate following graft rejection in bilateral corneal transplants in Iranian patients with keratoconus and to determine risk factors associated with rejection. Methods: In this retrospective study, data were compiled from records of patients who had undergone bilateral penetrating keratoplasty (PK) for keratoconus between 1988 and 2007. In order to estimate cure rate in patients with and without corneal vascularization, we adopted the cure rate frailty model with a Bayesian approach. Results: Two hundred and thirty-eight eyes of 119 patients underwent bilateral corneal transplantion for keratoconus, of which 22.7% experienced graft rejections. Cure rates for patients with and without corneal vascularization were 41% and 79%, respectively. Cure rate decreased 12% per decade of increase in recipient age. The 1, 5, and 10-year survival of corneal transplants without any graft rejection episodes were 82%, 74%, and 70% respectively. Conclusion: The most important risk factor predisposing to rejection in patients undergoing bilateral PK for keratoconus was corneal vascularization. Cure rate for patients without vascularization was high in this data set, indicating that penetrating keratoplasty in keratoconus patients without vascularization is an efficient and reliable procedure.

Background Effect of seasonal changes in human reproduction has been intensively researched. Some studies acknowledge influences of seasonal variation on natural conception, while others can not confirm them. The aim of this study was to investigate the effect of seasonal changes on different stages of assisted reproductive technology (ART) in Tehran. Materials and methods This study was carried out on 268 cycles which were the first intracytoplasmic sperm injection (ICSI) cycle of the couples between July 2005 and March 2007. Multiple logistic regression was used to model the influence of different clinical factors on pregnancy rate and a bivariate Poisson regression model was used for modeling the number of mature oocytes and obtained embryos. Results Based on the logistic regression model, the duration of infertility, female age, number of mature oocytes, and transferred embryos were only the significant predictors. In this series, seasonal changes had no predictive value on the pregnancy rate. Bivariate Poisson regression model showed that only the female age and duration of infertility were the factors simultaneously affecting the number of embryos and mature oocytes. Conclusion The suspected seasonal variability on the outcome of ICSI cycles has not been confirmed. Furthermore, among different seasons, there are no significant differences in the number of mature oocytes, obtained embryos, and transferred embryos.

No tools to assess women's general sexual and reproductive health needs have been validated in the Iranian context. This study in Sari in Mazandaran province of the Islamic Republic of Iran was conducted to evaluate the psychometric properties of a Persian version of the Sexual and Reproductive Health Needs Assessment Questionnaire (first developed for the International Organization for Migration and United Nations Population Fund). The Persian version of the questionnaire was found to have adequate face and content validity (quantitative and qualitative) for assessing sexual and reproductive health needs among women (content validity index = 0.88). The test-retest reliability showed that, except for the domain of sexually transmitted infections, all domains of the questionnaire had an acceptable reliability (intra-class correlation coefficients0.5). This questionnaire is a valid tool for assessing the sexual and reproductive health needs of Iranian women and planning/designing strategies to meet them.الخصائص القياسية النفسية (الخصائص السيكومترية) للنسخة الفارسية لاستبيان تقييم احتياجات الصحة الجنسية والإنجابية.صغرى خاني، ليدا مقدم بنائم، عيسى محمدي، أبوعلي ودادهير، إبراهيم حاجي زاده.لم يتم التحقُّق من صحة أي من الأدوات التي تقيِّم الاحتياجات العامة في مجال الصحة الجنسية والإنجابية للمرأة في السياق الإيراني. وقد أجريَت هذه الدراسة في ساري في محافظة مازندران بجمهورية إيران الإسلامية لتقييم خصائص القياس النفسي للنسخة الفارسية لاستبيان تقييم احتياجات الصحة الجنسية والإنجابية (الذي وضع أولاً للمنظمة الدولية للهجرة وصندوق الأمم المتحدة للسكان). وقد وجد أن النسخة الفارسية للاستبيان ذات وجه ملائم ومحتوى صحيح (كماً وكيفاً) لتقييم احتياجات الصحة الجنسية والإنجابية لدى النساء (مؤشر صحة المحتوى = 0.88). وأظهرت موثوقية الاختبار-إعادة الاختبار أن جميع ميادين الاستبيان ذات موثوقية مقبولة (مُعامِلات الترابط داخل الصنف0.5) باستثناء ميدان الأمراض المُعدية المنقولة جنسياً. وبذلك يعتبر هذا الاستبيان أداة صالحة لتقييم احتياجات الصحة الجنسية والإنجابية للمرأة الإيرانية ولوضع/تصميم استراتيجيات لتلبيتها.Propriétés psychométriques de la version en langue perse du Sexual and Reproductive Health Needs Assessment Questionnaire évaluant les besoins en santé sexuelle et génésique.Dans le contexte iranien, aucun outil évaluant les besoins généraux en santé sexuelle et génésique des femmes n'a été validé. La présente étude à Sari, dans la province de Mazandaran (République islamique d'Iran), a été menée afin d'évaluer les propriétés psychométriques de la version en langue perse du Sexual and Reproductive Health Needs Assessment Questionnaire (initialement élaboré pour l'Organisation internationale pour les migrations et le Fonds des Nations Unies pour la population). Il a été estimé que la version en langue perse du questionnaire avait une validité apparente et de contenu adéquate (quantitative et qualitative) pour évaluer les besoins en santé sexuelle et génésique des femmes (indice de validité de contenu = 0,88). La fiabilité d'un test-retest a démontré qu'à l'exception du domaine des infections sexuellement transmissibles, tous les domaines du questionnaire avaient une fiabilité acceptable (coefficients de corrélation intra-classe0,5). Le questionnaire est un outil valable pour évaluer les besoins en santé sexuelle et génésique des femmes iraniennes et pour prévoir/élaborer des stratégies qui y répondent.