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Objectives: Schizophrenia patients often experience relapses once and even more with no limit on number of relapses. The time among relapses are rarely considered in studies. The aim of this study was to identify some risk factors of time to elapses in schizophrenic patients with recurrent events model in survival analysis. Methods: In a retrospective longitudinal study, the medical records of 159 schizophrenic patients who referred to Razi hospital in Tehran from 2003 to 2005 were conveniently sampled, investigated and followed until the end of 2009. The time to recurrent relapses were considered in weeks. The patients with at least one relapse in this duration were included in the study. Event-dependent frailty model, using Bayesian approach, was applied to fit the data and identify the risk factors of time to relapses. Results: In this recurrent failure time model, the effects of age of onset (95% CI = (0.058, 0.086)), gender (95% CI = (0.146, 0.686)), marital status (95% CI = (0.475, 0.965)) and family history (95% CI = (0.115, 0.543)) were significant on the hazard time to relapses. According to the credible interval of frailty variance, elapsed time to relapse is dependent on patients' characteristics (95% CI = (0.084, 0.369)). Subsequent relapses are likely to be influenced by the occurrence of the first relapse, too (95% CI = (2.504, 3.079)), with decreasing hazard of time to relapse. Conclusions: Subsequent relapses are likely dependent on the first and previous relapses. Age of onset, gender, marital status and family history are important risk factors influencing hazard of time to relapses. More studies are required to clear out the effect of other covariates with this model. [ABSTRACT FROM AUTHOR]

BACKGROUND: Competing risks arise when the subject is exposed to more than one cause of failure. Data consists of the time that the subject failed and an indicator of which risk caused the subject to fail. METHODS: With three approaches consisting of Fine and Gray, binomial, and pseudo-value, all of which are directly based on cumulative incidence function, cardiovascular disease data of the Isfahan Cohort Study were analyzed. Validity of proportionality assumption for these approaches is the basis for selecting appropriate models. Such as for the Fine and Gray model, establishing proportionality assumption is necessary. In the binomial approach, a parametric, non-parametric, or semi-parametric model was offered according to validity of assumption. However, pseudo-value approaches do not need to establish proportionality. RESULTS: Following fitting the models to data, slight differences in parameters and variances estimates were seen among models. This showed that semi-parametric multiplicative model and the two models based on pseudo-value approach could be used for fitting this kind of data. CONCLUSION: We would recommend considering the use of competing risk models instead of normal survival methods when subjects are exposed to more than one cause of failure. [ABSTRACT FROM AUTHOR]

Objective(s) The objective of this study was to evaluate the effect of cannabinoid on cortical spreading depression (CSD) in rat brain. Cannabis has been used for centuries for both symptomatic and prophylactic treatment of different types of headaches including migraine. CSD is believed to be a putative neuronal mechanism underlying migraine aura and subsequent pain. Materials and Methods The effects of Delta9-tetrahydrocannabinol (THC), as well as, cannabinoid CB1 and CB2 receptor agonists on CSD in rat neocortical slices were investigated. Furthermore, the effect of cannabinoid CB1 agonist was tested on field excitatory postsynaptic potentials (fEPSP) and long-term potentiation (LTP). Results HC (1-20 microM) dose dependently suppressed CSD amplitude, duration, and propagation velocity. Cannabinoid CB1 agonist, WIN 55,212-2 mesylate (1-10 microM), also significantly suppressed all characteristic features of CSD. However, cannabinoid CB2 agonist, JWH-133 (1-20 microM), did not affect CSD. FEPSP and induction of LTP were suppressed by application of WIN55212-2. Conclusion Suppression of CSD by activation of CB1 receptors points to the potential therapeutic effects of cannabinoids in migraine with aura. More research is needed before we know whether cannabinoids may be helpful in treating migraine pain. [ABSTRACT FROM AUTHOR]

Frailty is usually modeled as an unobserved random variable acting multiplicatively on the baseline hazard function, where a shared unobserved quantity in the intensity induces a positive correlation among the observed failure times. Using the asymptotic properties of the nonparametric maximum likelihood estimator for the gamma frailty model, we derive a power function for testing the shared frailty parameter and evaluate the effect of number of groups and number of individuals per groups on the power of the test by simulation studies. The results show that choosing between 8 and 25 groups with sample sizes between 200 and 500 individuals will be enough to get a high power. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to identify risk factors for decayed, missing, and filled permanent teeth (DMFT) in a population of 12-15-year-old schoolchildren and to apply the marginalized zero-inflated negative binomial (MZINB) model for determination and estimation of the overall effects of the risk factors. A cross-sectional survey comprising 764 students aged between 12 and 15 years was used to analyze the association between caries in children and some background characteristics in children and their parents. Information on the samples' social, behavioral, and demographic status was obtained through a series of closed questions. The incidence rate ratios (IRR) were used to associate some risk factors with caries. In the entire sample, the frequency of zero was 194 (25.4%). The result of the shared-parameter marginalized zero-inflated negative binomial (SP-MZINB) model showed that being a girl (IRR = 1.18; p value = 0.021), higher dental visits frequency (IRR = 1.20; p value <0.001), lower tooth brushing frequency (IRR = 0.91; p value = 0.019), higher flossing frequency (IRR = 1.11; p value = 0.001), and lower mothers' education (IRR = 0.89; p value = 0.042) are associated with DMFT. Our results may provide better insights of the factors associated with DMFT, and health programs should focus their efforts on healthcare services, for both preventive and curative purposes. This regression model provides an appropriate fit and meaningful interpretation to handling zero-inflated count outcomes. Also, it provides direct estimates of the effects of risk factors on the overall mean that does not require postmodeling computations. [ABSTRACT FROM AUTHOR]

Pictures are often used in studies on memory, perception, and language; normative data are thus needed for such visual stimuli. In the present study, we aimed to obtain normative data for a set of 272 black-and-white pictures from middle-aged and elderly Persian speakers. A total of 206 volunteers were divided into two groups: a middle-aged (40-59 years old) group and an elderly (60 years old and over) group. The groups had similar characteristics in terms of education. Norms for every picture were developed to provide measures of name agreement, image agreement, conceptual familiarity, age of acquisition, and visual complexity. The results revealed that all of these measures vary with age, except for conceptual familiarity. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is one of the most prevalent cancers and significant causes of mortality in women. An important problem is the cancer cell metastasis in other organs. Different mechanisms in the beginning, progression, and metastasis of breast cancer makes it difficult to determine patients' ultimate fate (prognosis) and lifespan specifically although events ahead of the patients can be estimated using probabilities. This study was conducted to estimate the probability for the co-occurrence of metastasis and death at certain intervals of 5 years after surgery and 5 years after metastasis in patients with breast cancer. Methods: In this retrospective study, the data were collected from 608 women having breast cancer and going to the Breast Disease Center of ACECR in 2009-2001. The patients were studied from the time of surgery, and the two events were metastasis and death, respectively. The interval between the surgery and metastasis and that between the metastasis and death caused by cancer or end of follow-ups (for patients who did not die) were measured and analyzed in month. The probability for co-occurrence of the two intervals was estimated using the semiparametric method suggested by Una-Alvarez (2011) and R statistical software. Results: Median time for the occurrence of metastasis after surgery and duration of followup were 34 months and 66 months, respectively. In total, 93 metastases and 46 deaths occurred. The co-occurrence probability interval for all samples was 0.087-0. It was found that the probability for co-occurrence of the two events in patients with more than 50 years old, a tumor larger than 5 cm, lymph node involvement, high stage of the disease, positive HER2, negative ER, and without radiotherapy was greater than that in other groups. Conclusion: Considering the estimated co-occurrence probabilities, it seemed that factors such as the age over 50 years, tumors larger than 5 cm, lymph node involvement, higher stages, positive HER2, and negative ER increased the probability for the co-occurrence of metastasis and death in breast cancer patients. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Since the introduction of cochlear implantation, researchers have considered children's communication and educational success before and after implantation. Therefore, the present study aimed to compare auditory, speech, and language development scores following one-sided cochlear implantation between two groups of prelingual deaf children educated through either auditory-only (unisensory) or auditory–visual (bisensory) modes. Design: A randomized controlled trial with a single-factor experimental design was used. Methods: The study was conducted in the Instruction and Rehabilitation Private Centre of Hearing Impaired Children and their Family, called Soroosh in Shiraz, Iran. We assessed 30 Persian deaf children for eligibility and 22 children qualified to enter the study. They were aged between 27 and 66 months old and had been implanted between the ages of 15 and 63 months. The sample of 22 children was randomly assigned to two groups: auditory-only mode and auditory–visual mode; 11 participants in each group were analyzed. In both groups, the development of auditory perception, receptive language, expressive language, speech, and speech intelligibility was assessed pre- and post-intervention by means of instruments which were validated and standardized in the Persian population. Results: No significant differences were found between the two groups. The children with cochlear implants who had been instructed using either the auditory-only or auditory–visual modes acquired auditory, receptive language, expressive language, and speech skills at the same rate. Conclusion: Overall, spoken language significantly developed in both the unisensory group and the bisensory group. Thus, both the auditory-only mode and the auditory–visual mode were effective. Therefore, it is not essential to limit access to the visual modality and to rely solely on the auditory modality when instructing hearing, language, and speech in children with cochlear implants who are exposed to spoken language both at home and at school when communicating with their parents and educators prior to and after implantation. The trial has been registered at IRCT.ir, number IRCT201109267637N1. [Copyright &y& Elsevier]

The term usability refers to a special index for success of an operating system. This study aimed to determine the reliability and validity of the Software Usability Measurements Inventory (SUMI) questionnaire as one of the valid and common questionnaires about usability evaluation. The back translation method was used to translate the questionnaire from English to Persian back to English. Moreover, repeatability or test-retest reliability was practically used to determine the reliability of the SUMI questionnaire. The target population of the study consisted of all personnel of the governmental organizations in the city of Tehran, Iran, from whom 29 persons participated in the study to fill out the SUMI questionnaire. The Persian version of this questionnaire is available at designer's data bases under the title of IRSUMI_31. The obtained coefficients of reliability were 0.838 in testing step and 0.722 in re-testing step, respectively. The coefficients represented a satisfactory proof for the content validity and reliability of the questionnaire. The Persian version of SUMI questionnaire is applicable for all domestic made software as a valid and applicable factor. [ABSTRACT FROM AUTHOR]

Alzheimers disease (AD) is a genetically heterogeneous neurodegenerative disease and Late-Onset type (LOAD) is the most common form of dementia affecting people over 65 years old. CALHM1 (P86L) encodes a transmembrane glycoprotein that controls cytosolic Ca2+ concentrations and Aβ levels and P86L polymorphism in this gene is significantly associated with LOAD in independent case controls in a number of studies. This study was performed to determine whether this polymorphism contributes to the risk for LOAD in Iranian population. One hundred and forty one AD patients and 141 healthy controls were recruited in this study. After extraction of genomic DNA, the genotype and allele frequencies were determined in case and control subjects using PCR/RFLP method. The statistical analysis showed a significant difference in the heterozygote genotype frequency in case and control groups and polymorphic allele had a protective role between two groups. Also after stratifying the subjects by their APOE-ϵ4 status, no significant association was observed. Our study suggests that P86L polymorphism could be a protective factor for late-onset Alzheimer's disease (LOAD) in Iranian population. However, to confirm these results, further study with a bigger sample size may be required. [ABSTRACT FROM AUTHOR]

Alzheimers disease (AD) is a genetically heterogeneous neurodegenerative disease and Late-Onset type (LOAD) is the most common form of dementia affecting people over 65 years old. CALHM1 (P86L) encodes a transmembrane glycoprotein that controls cytosolic Ca2+ concentrations and Aβ levels and P86L polymorphism in this gene is significantly associated with LOAD in independent case controls in a number of studies. This study was performed to determine whether this polymorphism contributes to the risk for LOAD in Iranian population. One hundred and forty one AD patients and 141 healthy controls were recruited in this study. After extraction of genomic DNA, the genotype and allele frequencies were determined in case and control subjects using PCR/RFLP method. The statistical analysis showed a significant difference in the heterozygote genotype frequency in case and control groups and polymorphic allele had a protective role between two groups. Also after stratifying the subjects by their APOE-ϵ4 status, no significant association was observed. Our study suggests that P86L polymorphism could be a protective factor for late-onset Alzheimer's disease (LOAD) in Iranian population. However, to confirm these results, further study with a bigger sample size may be required. [ABSTRACT FROM AUTHOR]

Introduction: Late-onset Alzheimer's Disease (LOAD) is a neurodegenerative disorder and the most common form of dementia affecting people over 65 years old. Alzheimer's disease is a complex disease with multi-factorial etiology. Inflammation has been approved to have an important role in the pathogenesis of Alzheimer's disease (AD). TNF-α is a main pro-inflammatory cytokine that plays an essential role in initiation and regulation of inflammatory responses. Several studies have shown the probable association of polymorphism at TNF-α gene's promoter with AD pathogenesis. This study was performed to determine whether this polymorphism contributes to the risk for late-onset Alzheimer's disease (LOAD) in Iranian population. One hundred and forty AD patients and 158 healthy controls were recruited in the study. Following extraction of genomic DNA, using PCR/RFLP methods the genotype and allele frequencies were determined in case and control subjects. The statistical analysis showed no significant difference in the allele and genotype frequencies due to this polymorphism between the two groups. Also after stratifying the subjects by their APOE-ϵ4 status, no significant association was observed. Our results suggest that Tumor necrosis factor-alpha (TNF-α) -308 G/A is not a risk or protective factor for late-onset Alzheimer's disease in Iranian population. However, to confirm these results further study with a bigger sample size may be required. [ABSTRACT FROM AUTHOR]

PURPOSE. This study aims to assess the efficacy of Kangaroo Care (KC) on behavioral responses of term neonates to the pain of an intramuscular injection. DESIGN AND METHODS. One hundred healthy term neonates were enrolled and randomly assigned to intervention and control groups. In the intervention group, the neonate was held in KC for 10 min before the injection and remained in KC for the duration of the procedure. The primary outcome measure was the cumulative Neonatal Infant Pain Scale (NIPS) score immediately after injection. RESULTS. The cumulative NIPS score immediately after injection in the intervention group was significantly lower (p  < .001) than in the control group. PRACTICE IMPLICATIONS. KC given before injection seems to effectively decrease pain and should be considered for minor invasive procedures in neonates. [ABSTRACT FROM AUTHOR]

Background: Estimates of the annual prevalence for Obsessive Compulsive Disorder (OCD) were consistent across the international sites range, 1.9% - 2.5%. The nine population surveys, which used Diagnostic Interview Schedule, estimated a six-month prevalence of OCD ranging from 0.7% to 2.1%. This study performed in order to determine the prevalence of OCD in a population-based study among Iranian adults aged 18 and older and to study the association of them with factors such as sex, marital status, education, type of occupation and residential area. Methods: A cross-sectional nationwide epidemiological study of the Iranian population aged 18 and older was designed to estimate the prevalence of psychiatric disorders and their association with the above mentioned factors. 25180 individuals were selected and interviewed through a randomized systematic and cluster sampling method from all Iranian households. Schedule for Affective Disorders and Schizophrenia (SADS) and Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria were used in diagnosis of OCD. 250 clinical psychologists interviewed the selected subjects face to face at their homes. Results: The prevalence of OCD in Iran is 1.8% (0.7% and 2.8% in males and females; respectively). 50.3% of the survey sample were men, 49.9% women, 29.1% single, 67.45% married, 0.4% separated or divorced, 2.5% widow/widower and 4% undetermined. All of the above-mentioned factors were examined in the univariate and multivariate logistic regression models. Although the data did not fit the models well, but in univariate models, sex, the category "single" of marital status, age, the categories "business" and "housewife" and residential areas showed significant effect adjusting for the factors, but the models didn't fit the data properly. Conclusion: The study suggests that the prevalence of OCD is not rare in the community of Iran and is within the range of other countries. Similar to prior studies in other communities, OCD is more common in females than males. [ABSTRACT FROM AUTHOR]

The aim was to evaluate the lifetime prevalence of conduct disorder according to sociodemographic characteristics, determine the sociodemographic predictors of conduct disorder, and estimate the rates of comorbidities of psychiatric disorders in children and adolescents with conduct disorder by age and gender. The National Epidemiology of Iranian Children and Adolescents Psychiatric Disorders was a cross-sectional, general population-based study on 30,532 children and adolescents aged 6–18 years from all provinces of Iran, which was done using multistage cluster sampling. Iranian citizens aged 6–18 years who resided at least 1 year in each province were included, and children and adolescents with severe physical illnesses that prevented them to participate in the study were excluded. The sample weighting adjustment was used, since we had randomly selected the equal number of 1000 participants of each province from the urban and rural areas. Trained psychologists conducted diagnostic interviews with the adolescents and the children's parents using the Persian version of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children—Present and Lifetime Version (K-SADS—PL). In this study, 54 children aged 6–9 years (0.58%, CI 0.47–0.77), 64 adolescents aged 10–14 years (0.57%, CI 0.47–0.77), and 117 adolescents aged 15–18 years (1.22%, CI 0.96–1.44) met the criteria of the lifetime conduct disorder. Conduct disorder was significantly more common in boys than in girls, and was significantly less prevalent among those participants whose fathers had no history of psychiatric hospitalization. Of the participants with conduct disorder, 83.4% met the criteria for at least one other psychiatric disorder. Conduct disorder had a high rate of comorbidity with oppositional defiant disorder (54.89%, CI 48.50–61.12), attention-deficit/hyperactivity disorder (32.34%, CI 26.68–38.56), tobacco use (20.43%, CI 15.77–26.04), and depressive disorders (18.30%, CI 13.88–23.74). Because of using the diagnostic instrument, we found a low total rate of prevalence for conduct disorder; however, higher rates of it were observed among boys and adolescents. Further studies are needed to explore the nature of comorbidities of conduct disorder and to consider them in a large clinical population. [ABSTRACT FROM AUTHOR]

The article examine the prevalence rates of autism and its comorbidities among Iranian children and adolescents as part of a population-based study on epidemiology of psychiatric orders. Topics include the use of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Present and Life time version as the diagnostic tool, the link between maternal personality disorders and increasing risk of autism, and sex differences in comorbid conditions among children with autism.

Objective: Considering the impact of rapid sociocultural, political, and economical changes on societies and families, population-based surveys of mental disorders in different communities are needed to describe the magnitude of mental health problems and their disabling effects at the individual, familial, and societal levels. Method: A population-based cross sectional survey (IRCAP project) of 30 532 children and adolescents between 6 and 18 years was conducted in all provinces of Iran using a multistage cluster sampling method. Data were collected by 250 clinical psychologists trained to use the validated Persian version of the semi-structured diagnostic interview Kiddie-Schedule for Affective Disorders and Schizophrenia-PL (K-SADS-PL). Results: In this national epidemiological survey, 6209 out of 30 532 (22.31%) were diagnosed with at least one psychiatric disorder. The anxiety disorders (14.13%) and behavioral disorders (8.3%) had the highest prevalence, while eating disorders (0.13%) and psychotic symptoms (0.26%) had the lowest. The prevalence of psychiatric disorders was significantly lower in girls (OR = 0.85; 95% CI: 0.80-0.90), in those living in the rural area (OR = 0.80; 95% CI: 0.73-0.87), in those aged 15-18 years (OR = 0.92; 95% CI: 0.86-0.99), as well as that was significantly higher in those who had a parent suffering from mental disorders (OR = 1.96; 95% CI: 1.63-2.36 for mother and OR = 1.33; 95% CI: 1.07-1.66 for father) or physical illness (OR = 1.26; 95% CI: 1.17-1.35 for mother and OR = 1.19; 95% CI: 1.10-1.28 for father). Conclusion: About one fifth of Iranian children and adolescents suffer from at least one psychiatric disorder. Therefore, we should give a greater priority to promoting mental health and public health, provide more accessible services and trainings, and reduce barriers to accessing existing services. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore Iranian nurses' perceptions of and experiences with the antecedents and consequences of workplace violence perpetrated by patients, patients' relatives, colleagues and superiors. Background Workplace violence against nurses is a common problem worldwide, including in Iran. Although many studies have reviewed the antecedents and consequences of workplace violence, limited information is available on this topic. An understanding of the predisposing factors for violence and the consequences of violence is essential to developing programs to prevent and manage workplace violence. Design Qualitative descriptive design. Methods In this qualitative study, 22 unstructured, in-depth interviews were conducted with registered nurses who had experienced workplace violence and who were selecting using purposive sampling in nine hospitals. Inductive content analysis was used to analyse the data. Results Five categories emerged as predisposing factors: unmet expectations of patients/relatives, inefficient organisational management, inappropriate professional communication, factors related to nurses and factors related to patients, patients' relatives and colleagues. Individual, familial and professional consequences were identified as outcomes of workplace violence against nurses. Conclusions Workplace violence by patients/their relatives and colleagues/superiors is affected by various complicated factors at the individual and organisational levels. In addition to negatively affecting nurses' individual and family lives, workplace violence may lead to a lower quality of patient care and negative attitudes towards the nursing profession. Relevance to clinical practice Identifying factors, which lead to workplace violence, could help facilitate documenting and reporting such incidents as well as developing the necessary interventions to reduce them. Furthermore, native instruments must be developed to predict and monitor violence. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the effect of vestibular rehabilitation therapy program on the sensory organization of deaf children with bilateral vestibular dysfunction. This cross-sectional and analytic study was conducted on 24 students between the age of 7 and 12 years (6 girls and 18 boys) with the profound sensorineural hearing loss (PTA>90 dB). They were assessed through the balance subtest in Bruininks-Oseretsky test of motor proficiency (BOTMP). For children which the total score of the balance subtest was 3 standard deviation lower than their peers with typical development, vestibular function testing was completed pre-intervention. Posturography Sensory organization testing (SOT) was completed pre- and post-intervention with SPS (Synapsys, Marseille, France). Children with bilateral vestibular impairment were randomly assigned to either the exercise or control group. Exercise intervention consisted of compensatory training, emphasizing enhancement of visual and somatosensory function, and balance training. The exercise group entered in vestibular rehabilitation therapy program for 8 weeks. The children initially participating in the control group were provided the exercise intervention following the post-test. Based on the results there was significant difference in condition 5 and 6, areas of limits of stability (LOS), vestibular ratio and global score in posturography at the end of the intervention, but there was no significant difference in the control group in posturography (P<0.05). The results indicated that testing of vestibular, and postural control function, as well as intervention for deficiencies identified, should be included in deaf children rehabilitation program. © 2017 Tehran University of Medical Sciences. All rights reserved. [ABSTRACT FROM AUTHOR]

Background Cognitive impairment is common among older people and is associated with increased morbidity and mortality. The main aim of this study was to evaluate the validity of the Persian version of the Abbreviated Mental Test Score ( AMTS) as a screening tool for dementia. Methods Data were obtained from a cross-sectional study. One hundred and one older adults who were members of Iranian Alzheimer Association and 101 of their siblings were entered into this study by convenient sampling. The Diagnostic and Statistical Manual of Mental Disorders, 4th edition, criteria for diagnosing dementia and the Mini- Mental State Examination were used as the study tools. The gathered data were analyzed by the Mann- Whitney U-test, the Kruskal- Wallis test, Spearman's rank correlation coefficient, and the receiver-operating characteristic. Results The AMTS could successfully differentiate the dementia group from the non-dementia group. Scores were significantly correlated with Diagnostic and Statistical Manual of Mental Disorders diagnosis for dementia and Mini- Mental State Examination scores ( P < 0.001). Educational level ( P < 0.001) and male sex ( P = 0.015) were positively associated with AMTS, whereas ( P < 0.001) was negatively associated with AMTS. Total Cronbach's α coefficient was 0.90. The scores 6 and 7 showed the optimum balance between sensitivity (99% and 94%, respectively) and specificity (85% and 86%, respectively). Conclusions The Persian version of the AMTS is a valid cognitive assessment tool for older Iranian adults and can be used for dementia screening in Iran. [ABSTRACT FROM AUTHOR]

Background: Squamouscell carcinoma is the most common histological subtype of head and neck cancers. Methods: In a retrospective longitudinal study, we assessed the risk of local or metastatic recurrence and death in 140 patients with head and neck squamous cell carcinoma (HNSCC). Multivariate and shared frailty models were used for survival analysis with sex, primary tumor site, grade and stage of the tumor, and treatment modalities as contributing factors. Results: The most frequent site for HNSCC was the oral cavity (30%), followed by the tongue (26.4%). For most primary sites, men were at nearly 2-fold higher risk of local recurrence than women, but there was no difference by sex in the risk of metastatic recurrence. Undifferentiated HNSCC was associated with a higher risk of local recurrence (nearly 4-fold) and metastasis (6-15-fold based on the primary site) than well-differentiated tumors. In early months after surgical resection alone, the risk of local recurrence was higher compared to other treatment modalities. There was a strong dependency between the risk of local and metastatic recurrence. Conclusion: In conclusion, men diagnosed with HNSCC, those with higher grade or advanced state tumor, and those treated by surgery alone are at higher risk of unfavorable outcomes than others and may need more frequent follow-up visits. [ABSTRACT FROM AUTHOR]

Workplace violence against nurses is a challenging problem in both developed and developing countries. Because the concept of violence bears some cultural load, nurses' understanding is region-specific. This study explores Iranian nurses' perceptions of workplace violence. Using qualitative content analysis, 22 registered nurses underwent unstructured, in-depth interviews. The main themes of threats to human dignity and professional reputation emerged, plus four categories: physical violence, psychological violence, honor insults, and ethnic-religious insults. The term "honor insults," as a unique finding, was used instead of "sexual harassment." These findings may help to redefine workplace violence based on cultural background, design strategies for supporting nurses, and prevent and manage such violence. [ABSTRACT FROM AUTHOR]

This cross-sectional study aimed to determine the reliability of static control evaluation with Synapsys Posturography System (SPS, Marseille, France) and to compare the static postural control of deaf children with typically developing children. This study was conducted in 2 phases on 81 children of 7 to 12 years old in Tehran schools. The first phase examined the reliability of static balance evaluation with SPS. In this phase, a total of 12 children with typical development were evaluated and then do a re-test 1 week later. In the second phase, 30 children with profound sensorineural hearing loss (SNHL) and high risk in their balance (selected from Baghcheban Schools for the Deaf) as the experimental group, and 37 children with typical development (selected randomly from 2 primary schools for girls and boys in District 12 of Tehran Department of Education) as control group were enrolled in the study. They were all placed under sensory organization test evaluation. Based on the results of intraclass correlation coefficient (ICC), the unilateral random effects model, test-retest reliability in different sensory conditions, the moderate to excellent results were obtained (ICC between 0.68 and 0.94). Also, the mean displacement of pressure center in all sensory conditions, the limits of stability (LOS) area, the overall balance scores, and scores for balance sensory ratio (except the somatosensory ratio) of children with typical development were better than the deaf peers (P<0.05). The SPS has acceptable reliability to evaluate static posture in children between the ages of 7 and 12 years. Furthermore, deaf children as compared to children with typical development had a lower static postural control in all sensory conditions. This finding confirms the need to examine the postural control for identifying the extent of sensory deficit that has caused poor balance function, and also the need for early intervention to address the balance deficit in deaf children. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the static and dynamic balance performance of deaf children with and without cochlear implants. This is a cross-sectional study of 145 school children, aged between 7 and 12 years comprising 85 children with congenital or early acquired bilateral profound sensorineural hearing loss (the hearing loss group) and 60 normal hearing aged-matched control counterparts were assessed using the balance subtest of Bruininks-Oseretsky test of Motor Proficiency (BOTMP). The hearing loss group, 50 without cochlear implants (the non-implant group) and 35 of them with unilateral cochlear implants (the implant group) were recruited from schools for the deaf and normal hearing children (the control group) randomly selected from two randomly selected elementary schools of Tehran city. The scores were analyzed using one-way ANOVA. The total score of deaf children especially the implant group were significantly lower than the control group (P<0.001). The balance performance of the control group was better than the implant group in all of the items as well as the non-implant group except the fourth tested item (walking forward on a line) (P<0.05). The balance score of the implant group was significantly lower than the non-implant group except for the third tested item (standing on the preferred leg on a balance beam with eyes closed). The findings suggested that deaf children, specifically those with cochlear implants are at risk for motor and balance deficits. Thus, vestibular and motor evaluations, as well as interventions to improve balance and motor skills, should be prioritized for this population. [ABSTRACT FROM AUTHOR]

Current experimental research on the therapeutic effects of galvanic vestibular stimulation (GVS) has mainly focused on neurodegenerative disorders. However, it primarily stimulates the vestibular nuclei and could be potentially effective in modulating imbalance between them in the case of unilateral labyrinthectomy (UL). Fifty male Wistar rats (180–220 g) were used in 5 groups of 10: intact, sham, right-UL (RUL; without intervention), and two other right-UL groups with GVS intervention [one group treated with low rate GVS (GVS.LF; 6–7 Hz), and the other treated with high rate GVS (GVS.HF; 17–18 Hz)]. The UL models were prepared by intratympanic injection of sodium arsanilate. GVS protocols were implemented 30 min/day and continued for 14 days via ring-shaped copper electrodes inserted subcutaneously over each mastoid. Functional recovery was assessed by several postural tests including support surface area, landing and air-righting reflexes, and rotarod procedure. Immunohistochemical investigations were performed on ipsi- and contra-lesional medial vestibular nuclei (MVN) using bromodeoxyuridine (BrdU) and Ki67, as markers of cell proliferation. Behavioral evaluations showed significant functional recovery of GVS-treated groups compared to RUL group. The percent of marked cells with BrdU and Ki67 were significantly higher in the ipsilesional MVN of both GVS-treated groups compared with other groups. Our findings confirmed the effectiveness of GVS-intervention in accelerating static and dynamic vestibular compensation. This could be explained by the cell proliferation in ipsilesional MVN cells and rapid rebalancing of the VNs and the modulation of their motor outputs. Therefore, GVS could be promising for rehabilitating patients with unilateral vestibular weakness. [ABSTRACT FROM AUTHOR]

The present study determined how to elicit language samples from Farsi-speaking children, which language measures should be analysed, and whether these analyses are reliable. Two valid sets of picture stories were developed to elicit the language samples. Language measures were chosen by a panel of experts and the reliability of the measures was verified by test–retest reliability. The subjects were children 5–6 years of age (N = 30) who told stories twice at a 7–10 day interval. The results of inter-rater reliability showed that consistency of measurement was high for the transcription and analysis of the stories. The results of test–retest reliability showed there was a correlation between most variables in the longer samples (p < .05). This study demonstrates that language ability can be more reliably assessed when longer language samples are collected. [ABSTRACT FROM PUBLISHER]

Objective: Studies have shown the presence of narrative discourse difficulties in persons with traumatic brain injury (TBI), even in those who do not suffer from aphasia. Yet, there still exist inconsistencies between the results of different studies, in particular at the microlinguistic level. Moreover, a limited number of languages have been studied in this regard. Therefore, this study aimed at examining these skills in Persian-speaking individuals with TBI. The purpose of this pilot study was to analyse the microlinguistic and macrolinguistic skills of these individuals to determine impaired linguistic measures at different levels of narrative discourse. Participants and Methods: Fourteen non-aphasic Persian-speaking persons with TBI (9 with severe TBI and 5 with moderate TBI), aged 19-40 years (mean = 25.84, SD = 5.69), and 61 age-matched healthy adults completed a narrative task. Measures of language productivity, clause density, verbal error ratio, and cohesion ratio were calculated. Also, test-retest and inter-rater reliability coefficients were analysed. Results: The TBI group was impaired in some microlinguistic and all macrolinguistic measures compared to their control peers. Conclusion: The results of this study suggest that multi-level narrative discourse analyses of Persian-speaking individuals with TBI may be useful for speech/language pathologists wishing to evaluate communication disorders in persons with TBI. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Various studies have shown that stroke morbidity and mortality could be decreased if patients receive early diagnosis and treatment. Iranian Pre-hospital Stroke Scale (IPSS) is designed based on other pre- hospital stroke scales available across the world as well as experiences of emergency medicine specialists and pre-hospital emergency technicians to improve the diagnostic accuracy of the stroke scale in Iran. Methods: Using a mixed method, the study was carried out in two main phases. In the first phase, concept elicitation was conducted based on the review of the literature. Related stroke diagnosis and usual instruments in pre-hospital emergency stroke centers were documented. The IPSS was designed based on semi- structured interviews with 35 neurologists, emergency medicine practitioners and physicians working in hospitals and emergency technicians in the pre-hospital field. In the second phase, the face and content validity, and reliability were checked. Results: According to results from the first phase of this study (items generation), three domains were introduced as the most important factors in detection of early signs and symptoms of stroke. In the second phase (items reduction), the face validity of the IPSS was checked based on the comments from participants (the experts and EMS technicians). The content validity was calculated based on Lawshe index. The IPSS scale content validity index (S-CVI/Ave) was calculated as 89%. To determine the criterion validity of the instrument, the IPSS scores were compared with the final diagnosis based on results from brain CT scan in hospital. Conclusion: During this study we developed IPSS to be used by emergency technicians in pre-hospital field with a dichotomous items and simple and easy administration. It is recommended for future studies to apply this tool to emergency dispatch units as well as triage procedures in hospitals. [ABSTRACT FROM AUTHOR]

Background and Aim: The language sample analysis (LSA) is more common in other languages than Persian to study language development and assess language pathology. We studied some psychometric properties of language sample analysis in this research such as content validity of written story and its pictures, test-retest reliability, and inter-rater reliability. Methods: We wrote a story based on Persian culture from Schneider's study. The validity of written story and drawn pictures was approved by experts. To study test-retest reliability, 30 children looked at the pictures and told their own story twice with 7-10 days interval. Children generated the story themselves and tester did not give any cue about the story. Their audio-taped story was transcribed and analyzed. Sentence and word structures were detected in the analysis. Results: Mean of experts' agreement with the validity of written story was 92.28 percent. Experts scored the quality of pictures high and excellent. There was correlation between variables in sentence and word structure (p<0.05) in test-retest, except complex sentences (p=0.137). The agreement rate was 97.1 percent in inter-rater reliability assessment of transcription. The results of inter-rater reliability of language analysis showed that correlation coefficients were significant. Conclusion: The results confirmed that the tool was valid for eliciting language sample. The consistency of language performance in repeated measurement varied from mild to high in language sample analysis approach. [ABSTRACT FROM AUTHOR]

Background and Aim: Several studies have demonstrated deficits in rapid naming in dyslexic readers; however the extent of deficit is different in various orthographies. This study was intended to survey the naming speed in Persian children with dyslexia. Methods: Rapid automatized naming (RAN) task of 19 children with dyslexia were compared with 31 nondyslexic children. Participants were selected from the students of the second grade of primary schools in Tehran city, Iran, with normal intelligence [intelligence quotient]. Nondyslexic children were at the age of 7.7 to 8.7 years (mean=7.6) and dyslexics were 7.8 to 9.4 years old (mean=8.1). Reading accuracy and speed were assessed by text reading (Diagnostic Reading Test), and high frequency word, low frequency word and nonword reading (Reading and Dyslexia Test). Results: Dyslexic readers needed more time than non-dyslexics when naming objects (p<0.001), numbers (p=0.001) and letters (p<0.001). The mean of dyslexics z-scores were -1.98 on objects, -1.96 on numbers and - 3.35 on letters. 42% of dyslexics did not show any deficit on rapid automatized naming task. All of the subtests were correlated to reading speed (p<0.050), but among subtests of rapid automatized naming task, only letter naming was correlated to reading accuracy (p<0.050). Conclusion: More than half of dyslexics cases showed an apparent deficit in naming speed (objects, numbers and letters), which was more evident at letters. Naming speed was related to reading accuracy and reading speed; although the relationship was stronger with the second one. [ABSTRACT FROM AUTHOR]

Objectives: An essential need in Iran for the application of stuttering self-rating tools for the people who stutter (PWS) and its conversion into Persian language has encouraged this research to examine the validity and reliability of Wright and Ayre Stuttering Self-Rating Profile (WASSP) test to the benefits of adult Persianspeaking individuals who stutter. WASSP is an excellent tool for assessment and measuring outcomes and a beneficial tool for clinicians and clients as well. So, the purpose of this study is to examine the content validity by some speech and language pathologists in Iran, then to evaluate the reliability of the WASSP test for adult Persianspeaking people with stutter. Methods and Procedure: The participants were 24 (20 males and 4 females) stutterers who were Persian speaking, 18- 30 years old (mean 24 years) with no medical or behavioral problems. 20 skilled Speech - Language pathologists (SLPs) who were independent of the research, participated in the study to evaluate translation and content validity of the test. Cronbach's alpha coefficients were used to assess internal consistency of items and reliability assessed by estimating Intraclass Correlation Coefficients (ICC) in test-retest study. Results: Results indicate that ICC for all sub-scales were in 0.76-0.99 and all correlation coefficients among total subscales scores at each time of testing in 0.87-0.97 range. Internal consistency coefficients for items of sub-scales at each time of testing were above 0.78 (0.78-0.96). Conclusions: The Persian version of WASSP test provides a valid and reliable tool to assess the self-rating of stuttering in Persian language and overt and covert aspects of stuttering. SLPs will be able to determine PWS test scores to manage their accurate treatment and future planning [ABSTRACT FROM AUTHOR]

Background and Aim: An imbalance between phonatory subsystems may lead to disturbing phonatory muscular balance and consequently voice disorders. Based on theoretical issues, criterion-based laryngeal manual therapy, as a novel treatment method which is supported by classical laryngeal manual therapy, can improve voice quality using manual maneuvers combined with phonatory tasks. The present study aimed to report the treating effects of this method on hyperfunctional voice disorders. Methods: Twenty adult participants with hyperfunctional voice disorders by the least three months history of voice disorder were selected. The participant's voices were assessed multidimensionally using acoustic, audio-pecreptual and stroboscopic assessments before and after treatment. Results: There were a decrease in jitter (p=0.003) and shimmer (p<0.001) and also, increase in harmonic-to-noise ratio (HNR) (p<0.001) of vowel /a/ after treatment. Besides, there was an increase in harmony to noise ratio (p=0.009) and decrease in jitter (p=0.020) of vowel /i/, too. There were not significant changes in shimmer amount of vowel /i/ (p=0.170) after treatment. There were highly significant changes in all aspects of audio-perceptual (p<0.001) and videostroboscopic (p<0.001) parameters. Conclusion: Using voice-based laryngeal manual therapy can be a treatment method in handling hyperfunctional voice disorders. [ABSTRACT FROM AUTHOR]

Survival analysis methods deal with a type of data, which is waiting time till occurrence of an event. One common method to analyze this sort of data is Cox regression. Sometimes, the underlying assumptions of the model are not true, such as nonproportionality for the Cox model. In model building, choosing an appropriate model depends on complexity and the characteristics of the data that effect the appropriateness of the model. One strategy, which is used nowadays frequently, is artificial neural network (ANN) model which needs a minimal assumption. This study aimed to compare predictions of the ANN and Cox models by simulated data sets, which the average censoring rate were considered 20% to 80% in both simple and complex model. All simulations and comparisons were performed by R 2.14.1. [ABSTRACT FROM AUTHOR]

Objective(s) Alzheimer's disease (AD) is a complex disease with multifactorial etiology. Inflammation has been proven to have an important role in the pathogenesis of AD. Both CCR2 and CCR5 genes expression increase in AD patients comparing to control subjects. CCR5 gene encodes a protein which is a member of the beta chemokine receptors family of integral membrane proteins. CCR5-Δ32 is a genetic variant of CCR5 and is characterized by the presence of a 32-bp deletion in the coding region of the gene, which leads to the expression of a nonfunctional receptor, and the CCR2-64I has a change of valine to isoleucine at codon 64, in the first transmembrane domain. It has been proved that both genes have important roles in different stages of inflammation. Materials and Methods The frequencies of CCR5Δ32 and CCR2-64I variations were determined in 156 AD patients and 161 control subjects using polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) methods, and the results were compared among AD and healthy controls. Results Statistical analysis showed no significant difference in the distributions of CCR5Δ32 and CCR2-64I between the AD patients and healthy controls (P> 0.05). Stratifying the samples by gender, genetic background and presence of ApoEε4 allele showed no significant effect on the distributions of CCR5Δ32 and CCR2-64I (P> 0.05). Conclusion Our study did not show an association between CCR5Δ32 and CCR2-64I variations and AD in the Iranian population. Further confirmatory studies with bigger number of samples are recommended. [ABSTRACT FROM AUTHOR]

Background. There are very few studies that had a sample size sufficient to explore the association between factors related to low back pain in a representative sample of the Iranian population. Objective. To examine the relationship between sociodemographic factors, smoking, obesity, and low back pain in Iranian people. Methods. We used Iranian adults respondents (n = 25307) from the National Health Survey. Adjusted odds ratios and 95% confidence intervals were estimated by using logistic regression. Results. Theprevalence of low back pain was found in 29.3% of the studied sample. High age, female sex, being married, obesity, low-economic index, being smoker, in a rural residence, and low educational attainment, all increased the odds of low back pain. Conclusions. Our findings add to the evidence on the importance of obesity in relation to low back pain. These results can be used as a basis to reinforce health programs to prevent obesity. [ABSTRACT FROM AUTHOR]

Stroke is one of the most common causes of death and disability in Iran. This study evaluated stroke patient profiles with respect to rate, risk factors, and one-month fatality. A cross-sectional, hospital-based study on all stroke patients older than 45 years admitted to hospitals in the city of Qom throughout 2001. Four hundred and sixty patients older than 45 years were admitted as stroke. The annual stroke rate was estimated to 338/100 000 (95% confidence interval, 300-360) inhabitants older than 45 years. The annual rate of stroke was 384/100 000 (95% confidence interval, 381-386) when adjusted to the European population. Stroke subtypes were; ischaemic infarction 75%, intracranial haemorrhage 20·7%, subarachnoid haemorrhage 3%, and undetermined 1·3%. Main risk factors were hypertension in 74·6% and diabetes in 55·7%. Mortality rate was 24·6% within the first month. Stroke incidence was higher than in Western countries. Hypertension and diabetes mellitus were considerably more frequent in our studied stroke patients than in other developing countries. Our findings need to be addressed in future health education programmes in Iran identifying patients at risk and focusing on more aggressive prevention programmes to lower stroke incidence. [ABSTRACT FROM AUTHOR]

Spasticity is one of the common complications in upper motor neuron lesions and without appropriate treatment it causes disturbances in movement pattern. Assessments of patients are effective in patient`s management. Modified Ashworth scale (MAS) is one of the criteria in qualitative assessment of spasticity, and there are lots of controversies about its validity. The purpose of this study is to compare MAS with electrophysiological indices of spasticity. The spasticity of upper limb muscles in patients with hemiplegic cerebral palsy are measured and recorded by MAS. Then electrophysiological indices of Hoffmann reflex (H reflex) and ratio of maximum range of action potential of combined movement of flexor carpi radialis (FCR) for upper limb and soleus for lower limb were estimated. Data of 11 patients with age range 4 to 6 were analyzed. There is no significant correlation between degree of spasticity and electrophysiological indices. [ABSTRACT FROM AUTHOR]

Background: Constraint-Induced movement therapy (CIMT) is a promising treatment for improving upper limb function in adults after stroke and traumatic brain injury. It involves constraint of the less affected limb and intensive practice with the more affected limb. The purpose of this study on children with hemiplegic cerebral palsy (CP) was to evaluate the effects of CIMT on upper extremity and to make a comparison with conventional treatment. Methods: I a randomized clinical trial twelve children (seven females, five males; aged between 48 and 72 months with mean±standard deviation of 59.91±9.15mo) were randomly assigned in two groups. An intensive occupational therapy program including five hours per day for 21 consecutive days was performed for all of them, while less affected limbs were placed in sling for immobilization. Before and after intervention, upper extremity function, spasticity, and motor neuron excitation were evaluated by means of peabody developmental motor scales, modified Ashworth scale, and H reflex and H/M ratio, respectively. Results: The children who received CIMT did not improved their ability to use their hemiplegic hand significantly more than the children in the control group (p>0.05). However, reports of caregivers and clinical observations showed increases in more affected limb frequency of use and quality of movement. Conclusion: Results suggest that the use of CIMT needs to more studies and should be considered experimental in children with hemiplegic CP. [ABSTRACT FROM AUTHOR]

The article presents a study on the validity and reliability of the Persian version of The Spirituality and Spiritual Care Rating Scale (SSCRS). The researchers stress that despite being committed to the concept of holistic nursing, the nursing practice does not always address the spiritual needs of patients. The nurses at the Razi Psychiatric Center in Tehran, Iran participated in the study. It is said that the study has provided information on how psychiatric nurses in Iran perceive spiritual care.

The aim of this study was to determine the effect of a nurse-delivered spiritual care intervention on depression following coronary artery bypass graft (CABG) surgery. A semi-experimental study was performed in Baqiyatallah al-Azam Military Hospital of Tehran, Iran in 2013. Sixty-eight patients undergoing coronary artery grafts were purposefully selected and randomly assigned into the intervention (n = 34) and control (usual care) groups (n = 34). The intervention group received five sessions of spiritual care lasting between 45–60 minutes using the approach of Bergin Richards (2005). The control group received only routine standard care. The mean depression scores were measured using the depression subscale of the Depression Anxiety Stress Scale (DASS-21). At baseline (p = 0.051), there were no differences in the mean depression scores. Post intervention, statistically significant differences were observed in the mean depression scores between groups (p < 0.001). The results showed that the use of spiritual care can decrease depression in the intervention group. These findings suggested that nurses could use spiritual care to improve psychological care. [ABSTRACT FROM AUTHOR]