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1.  Body image satisfaction and self-esteem status among the patients with polycystic ovary syndrome 
Background: Most previous research has focused on polycystic ovary syndrome (PCOS) characteristics and their association with psychological disorders, such as anxiety and depression.
Objective: In the present study, our aim was to study whether PCOS characteristics are associated with several aspects of psychological well-being namely self-esteem and body satisfaction.
Materials and Methods: This was a cross-sectional study of 300 women with PCOS that was carried out in Kashan, Iran. Main outcome measures were the Body Image Concern Inventory (BICI) and the Rosenberg’s Self-Esteem Scale and clinical information of PCOS. Major clinical PCOS features including obesity (BMI), excessive body hair (hirsutism score), acne, menstrual cycle disturbances and infertility.
Results: The findings of regression analysis indicated that infertile women had lower levels of self-esteem (=-0.11, p=0.049) and poorer body satisfaction (=0.121, p=0.036) compared with PCOS women without infertility. Furthermore, hirsute women experienced poorer self-esteem than women without hirsutism (=-0.124, p=0.032). Women with menstrual irregularities had higher body dissatisfaction (=0.159, p=0.005). Moreover, women with higher body mass index scores had poorer body satisfaction (=0.151, p=0.009) but were not associated with self-esteem.
Conclusion: The emotional well-being of the patients presenting with the syndrome needs to be recognized more fully, particularly in relation to the low self-esteem, poor body image, and struggles with weight, menstrual irregularities, hirsutism and infertility. The results of this study raise implications for clinical practice and suggest that a multidisciplinary approach to the management of women with PCOS.
This article extracted from Ph.D. thesis. (Fatemeh Bazarganipour)
PMCID: PMC3941334  PMID: 24639704
Polycysticovarysyndrome; Self-esteem; Bodyimage.
2.  A retrospective cohort study on factors associated blood pressure using multilevel modeling 
ARYA Atherosclerosis  2013;9(5):293-299.
Hypertension is a health problem in Iran. Given the importance of this subject, we reviewed the factors affecting the blood pressure in this survey.
This retrospective cohort study was performed on 3961 male workers employed at Isfahan Polyacryl Corporation (Iran) in health and safety executive between 1996 until 2008. In this study, systolic and diastolic blood pressure (SBP and DBP) were considered as dependent variables; body mass index (BMI), age, type of job, marital status, shift work and educational level were considered as independent variables. MLwiN programmer version 2.1 was used to analyze the data.
BMI, age, shift work, marital status and educational level had statistical significant association with DBP. The result for SBP was similar to DBP except shift work and educational level that had no statistically significant association.
The results can be considered in the industry to provide practical solutions to reduce blood pressure.
PMCID: PMC3845696  PMID: 24302938
Blood Pressure; Cohort Study; Retrospective Study; Risk Factor; Multilevel Anal
3.  Application of semi-parametric single-index two-part regression and parametric two-part regression in estimation of the cost of functional gastrointestinal disorders 
For the purpose of cost modeling, the semi-parametric single-index two-part model was utilized in the paper. Furthermore, as functional gastrointestinal diseases which are well-known as common causes of illness among the society people in terms of both the number of patients and prevalence in a specific time interval, this research estimated the average cost of functional gastrointestinal diseases.
Health care policy-makers seek for real and accurate estimations of society's future medical costs. However, data dealt with in hygienic studies have characteristics which make their analysis complicated; distribution of cost data is highly skewed since many patients pay great costs. In addition, medical costs of many persons are zero in a specific time interval. Indeed, medical costs data are often right skewed, including remarkable number of zeros, and may be distributed non-homogeneously.
Patients and methods
In modeling these costs by the semi-parametric single-index two-part model, parameters were determined by method of least squares; a result of this method was compared with the results yielded from two-part parametric model.
Average costs of functional gastrointestinal diseases and their standard deviation in semi-parametric and parametric methods were yielded as $72.69±108.96 (R2=0.38) and $75.93±122.29 (R2=0.33) respectively.
Based on R2 index, the semi-parametric model is recognized as the best model. Totally, the two-part parametric regression model is a simple and available model which can be easily interpreted; on the other hand, though the single-index two-part semi-parametric model cannot be easily interpreted, it has considerable flexibility. The study goals can be indeed used as the main factor for choosing one of these two models.
PMCID: PMC4017520  PMID: 24834273
Semi-parametric regression; Two-part model; Single-index model; Semi-parametric least squares
4.  Psychological investigation in patients with polycystic ovary syndrome 
The aim of the present study was to estimate the prevalence of mood disorders and examine a range of predictors for psychological well-being among Iranian women with polycystic ovary syndrome (PCOS).
A cross-sectional study was undertaken to ascertain the factors related to psychological distress in PCOS patients in Kashan, Iran. Psychological distress was measured using the Hospital Anxiety and Depression Scale (HADS). In addition we assessed quality of life using the Short Form Health Survey (SF-36). Socio-demographic details and clinical information of PCOS including obesity (body mass index), excessive body hair (hirsutism score), acne, menstrual cycle disturbances, infertility and endocrine profile also were recorded for each patient.
In all 300 women with PCOS were entered into the study. Of these 32% (n =96) showed elevated HADS anxiety while depression was high in 5% (n =15). Quality of life was significantly impaired in women with anxiety (P <0.05), and depression (P <0.001) and in particular, in women with coexistence anxiety and depression (P <0.001) compared with unaffected participants. Compared with the non-depressed PCOS patients, the depressed women had significantly higher menstrual irregularities (P = 0.008). Moreover, we found significant difference in FAI level between the depressed and non depressed (p = 0.05), the anxious and non anxious patients (p < 0.001) compare to non affected PCOS women.
The high prevalence of depression and anxiety in this population suggests that initial evaluation of all women with PCOS should also include assessment of mental health disorders. The clinician should further pay attention to background of their patients especially in view of the factors influencing psychological well-being.
PMCID: PMC3751454  PMID: 23947827
Anxiety; Depression; Quality of life; Polycystic ovary syndrome
5.  Historical Cohort Study on the Factors Affecting Blood Pressure in Workers of Polyacryl Iran Corporation Using Bayesian Multilevel Modeling with Skew T Distribution 
Hypertension is considered as a major public health problem in most countries due to its association with ischemic heart disease which causes cerebrovascular disease and death.
The purpose of the present study was to study factors affecting Blood Pressure (BP).
Patients and Methods
The data were extracted from annual observation of the workers who worked in Polyacryl Iran Corporation (PIC) between 1998 and 2010. In this research, we assessed the effect of Body Mass Index (BMI), age, sex, job status, marital status, job schedule type, and education level on Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) using Bayesian multilevel modeling with skew t distribution using WinBUGS software.
Totally 3965 persons participated in this study, 75(1.9%) female and 3890 (98.1%) male. In this study age, sex, BMI, job status, marital status, and education level had statistical association with SBP. The result for DBP was similar to SBP except the education level which had no statistical association.
Treating obesity, increasing physical activity and quality of married life are proposed as practical solutions to reduce BP.
PMCID: PMC3838653  PMID: 24349731
Blood Pressure; Cohort Studies; Multilevel Analysis
6.  Lipoprotein Lipase HindIII Intronic Polymorphism in a Subset of Iranian Patients with Late-Onset Alzheimer’s Disease 
Cell Journal (Yakhteh)  2012;14(1):67-72.
Lipid metabolism is involved in the pathogenesis of late-onset Alzheimer’s disease (LOAD). Lipoprotein lipase (LPL) is a multifunctional enzyme that plays a major role in lipid metabolism; its abnormal function seems to be related, either directly or indirectly, to the pathogenesis of many diseases such as atherosclerosis, coronary artery disease (CAD) and Alzheimer’s disease (AD) . HindIII polymorphism is a common LPL genetic variant shown to increase the risk of LOAD. The present research investigates whether this polymorphism is involved in the pathogenesis of Iranian LOAD patients.
Materials and Methods:
In this case control study ,allele and genotype frequencies for the HindIII polymorphism of the LPL gene in 100 patients affected with LOAD and 100 healthy controls were determined by reaction-restriction fragment length polymorphism (PCR-RFLP) and compared using the chi-square and Fisher’s exact tests.
LPL H+H+ genotype frequency in LOAD patients was 58%, which was significantly higher than controls (44%). There was a 1.75-fold increased risk for the development of LOAD in carriers of the H+H+ genotype compared to non-carriers (OR=1.75; 95%CI: 1.00-3.07; p=0.048). When adjusted for sex, the H+H+ genotype was more frequent in patients than controls; this difference was more remarkable in males (OR: 1.90; 95% CI: 1.08-3.34; p=0.024). The mean age of disease onset did not differ in patients with the LPL H+H+ genotype compared to unaffected individuals.
This study confirms the association between the H+H+ genotype with LOAD and supports the correlation of this genotype of the LPL gene with risk of developing LOAD in Iranian patients with AD.
PMCID: PMC3635823  PMID: 23626940
Alzheimer’s Disease; LPL Gene; HindIII Polymorphism; Association Study
7.  Assessing Awareness Level about Warning Signs of Cancer and its Determinants in an Iranian General Population 
The present study was aimed at investigating the awareness level about warning signs of cancer and its determinants in an Iranian general population. This cross-sectional interview-based survey investigated 2,500 people aged 18 years and over, as a representative sample of Tehran population. Latent class regression was applied for analyzing data. A small (18.8%) proportion of the respondents had high level of knowledge, and 54.5% had moderate awareness, and 26.7% had low level of awareness. Most effective predictors for awareness were educational attainment, sex, and marital status. The findings suggest that the overall level of knowledge about warning signs of cancer among the public is low, particularly about some specific signs. Accordingly, educational and intervention programmes, with special attention placed on particular at-risk populations, to increase awareness about the disease leading to its early diagnosis are needed.
PMCID: PMC3259730  PMID: 22283041
Awareness; Cancer; Cross-sectional studies; Health education; Neoplasms; Public education; Signs and symptoms; Iran
8.  Using skew-symmetric mixed models for investigating the effect of different diabetic macular edema treatments by analyzing central macular thickness and visual acuity responses 
Diabetic Macular Edema (DME) is one of the major causes of visual loss and increase in central macular thickness (CMT). The aim of this study was to determine the efficacy of a single intravitreal injection of bevacizumab (IVB) alone or in combination with intravitreal triamcinolone acetonide (IVB/IVT) versus macular laser photocoagulation (MPC) as primary treatment for DME when confounders were considered.
Skew-symmetric bivariate mixed modeling according to best corrected visual acuity (BCVA) and CMT was done on the data of 103 diabetic patients from ophthalmic research center of Labbafinejad medical center (Tehran, Iran) to determine the best DME treatment by adjusting the effect of confounders.
Although there was no significant difference between IVB/IVT (p > 0.05), these two treatments increased BCVA and decreased CMT better than MPC (p < 0.05). The following three groups showed better treatment responses: 1) women, 2) patients with more diabetes duration, 3) patients whose CMT were higher and VA were lower at the beginning of the clinical trial.
Using skew-symmetric mixed effect model as updated statistical method in presence of asymmetric or outlier data, we received different results compared to the same investigation on this study by analyzing BCVA and CMT simultaneously. This research demonstrated the effect of IVB alone or in combination with intravitreal IVB/IVT on visual power and decreasing CMT during follow up.
PMCID: PMC3430022  PMID: 22973326
Best-Corrected Visual Acuity; Central Macular Thickness; Diabetic Macular Edema; Skew-symmetric Mixed Models
9.  Does the prognosis of colorectal cancer vary with tumor site? 
The aim of this study was to compare prognostic factors between colon and rectal cancers.
Prognosis of Colorectal Cancer (CRC) may depend on the anatomical site.
Patients and methods
A total of 1219 patients with CRC diagnosis according to the pathology report of RCGLD cancer registry, from 1 January 2002 to 1 October 2007, were entered into the study. Demographic and clinico-pathological factors were analyzed using survival analysis.
From age at diagnosis, colon cancer had significantly better survival than rectal cancer (Multivariate Hazard Ratio (MVHR)=0.24; 95% Confidence Interval (CI) =(0.074-0.77)). Other factors, including marital status (MVHR =1.78; 95% CI =(0.33-9.62)), body mass index (BMI) (MVHR =1.21 and 1.54; 95% CI =(.30-4.85) and (.44-5.4) respectively for < 18.5 and >30 BMI groups), pathologic stage (MVHR =.64; 95% CI =(.21-1.98)) and alcohol history (MVHR =4.86; 95% CI =(.67-35.14)) were not significantly different between the two patient group but suggested a possible effect upon prognosis. Overall survival in rectum was better than that of colon.
Our findings support this hypothesis that prognosis of CRC varies with tumor site.
PMCID: PMC4017433  PMID: 24834183
Prognostic factors; Colorectal cancer; Survival analysis
10.  Iranian nurses’ perception of spirituality and spiritual care: a qualitative content analysis study 
The purpose of the present study was to explore nurses’ perception about spirituality and spiritual care. A qualitative content analysis approach was conducted on 20 registered nurses interviewed using unstructured strategy in 2009. Three themes emerged from the data analysis: 1) “meaning and purpose of work and life” including ‘spiritualistic view to profession’, ‘commitment and professional responsibility’, and ‘positive attitude’; 2) “religious attitude” including ‘God approval’, ‘spiritual reward’, ‘taking advice’, ‘inner belief in the Supreme Being’, ‘faith-based interactions and altruism’; 3) “transcendence-seeking” including ‘need for respect’ and ‘personal–professional transcendence’. Therefore, the spirituality produces maintenance, harmony and balance in nurses in relation to God. Spiritual care focuses on respecting patients, friendly and sympathetic interactions, sharing in rituals and strengthening patients and nurses’ inner energy.
This type of spirituality gives a positive perspective to life and profession, peaceful interactions, a harmonious state of mind, and acts as a motivator among nurses to promote nursing care and spirituality.
PMCID: PMC3713882  PMID: 23908741
Evaluation; Content analysis; Nurses’ spirituality; Spiritual care; Nurses’ lifestyle
11.  Postnatal quality of life in women after normal vaginal delivery and caesarean section 
Caesarean section might increase the incidence of surgical interventions and problems resulting from hospitalization and thus affecting quality of life in women after delivery. This study aimed to compare quality of life in women after normal delivery and caesarean section.
This was a prospective study. A sample of women with normal delivery and caesarean section from 5 health care centers in Isfahan, Iran were entered into the study. Quality of life was measured using the SF-36 at two points in time (time 1: 6 to 8 weeks after delivery; time 2: 12 to 14 weeks after delivery). Data were analyzed to compare quality of life in the two study groups.
In all 100 women were interviewed (50 with normal delivery and 50 with caesarean section). Postnatal quality of life in both groups was improved from time1 to time 2. However, comparing the mean scores between the normal and caesarean delivery groups the results showed that in general the normal vaginal delivery group had a better quality of life for almost all subscales in both assessment times. The differences were significant for vitality (mean score 62.9 vs. 54.4 P = 0.03) and mental health (mean score 75.1 vs. 66.7, P = 0.03) at first assessment and for physical functioning (mean score 88.4 vs. 81.5, P = 0.03) at second evaluation. However, comparing the findings within each group the analysis showed that the normal vaginal delivery group improved more on physical health related quality of life while the caesarean section group improved more on mental health related quality of life.
Although the study did not show a clear cut benefit in favor of either methods of delivery that are normal vaginal delivery or caesarean section, the findings suggest that normal vaginal delivery might lead to a better quality of life especially resulting in a superior physical health. Indeed in the absence of medical indications normal vaginal delivery might be better to be considered as the first priority in term pregnancy.
PMCID: PMC2640344  PMID: 19183480
12.  A school-based randomized controlled trial to improve physical activity among Iranian high school girls 
Physical activity (PA) rates decline precipitously during the high school years and are consistently lower among adolescent girls than adolescent boys. Due to cultural barriers, this problem might be exacerbated in female Iranian adolescents. However, little intervention research has been conducted to try to increase PA participation rates with this population. Because PA interventions in schools have the potential to reach many children and adolescents, this study reports on PA intervention research conducted in all-female Iranian high schools.
A randomized controlled trial was conducted to examine the effects of two six-month tailored interventions on potential determinants of PA and PA behavior. Students (N = 161) were randomly allocated to one of three conditions: an intervention based on Pender's Health Promotion model (HP), an intervention based on an integration of the health promotion model and selected constructs from the Transtheoretical model (THP), and a control group (CON). Measures were administered prior to the intervention, at post-intervention and at a six-month follow-up.
Repeated measure ANOVAs showed a significant interaction between group and time for perceived benefits, self efficacy, interpersonal norms, social support, behavioral processes, and PA behavior, indicating that both intervention groups significantly improved across the 24-week intervention, whereas the control group did not. Participants in the THP group showed greater use of counter conditioning and stimulus control at post-intervention and at follow-up. While there were no significant differences in PA between the HP and CON groups at follow-up, a significant difference was still found between the THP and the CON group.
This study provides the first evidence of the effectiveness of a PA intervention based on Pender's HP model combined with selected aspects of the TTM on potential determinants to increase PA among Iranian high school girls.
PMCID: PMC2386503  PMID: 18387174
13.  Modeling repeated ordinal responses using a family of power transformations: application to neonatal hypothermia data 
For analyzing a repeated ordinal response, it is common to use a multivariate cumulative logit model. This model may fit poorly, especially when a nonsymmetric response is available. In these cases, alternative strategies should be utilized.
In this paper, we present a family of power transformations for the cumulative probabilities to model asymmetric departures from the random-intercept cumulative logit model. To illustrate this method, we analyze the data from an epidemiologic study to identify risk factors of hypothermia among newly born infants in some referral university hospitals in Tehran, Iran.
For hypothermia data, using this family of transformations and comparing the goodness-of-fit statistics showed that a model with the cumulative complementary log-log link gives us a better fit compared to a model with the cumulative logit link.
In some areas, using the ordinary cumulative logit link function does not lead to the best fit. So, other link functions should be evaluated to discover the best transformation for the cumulative probabilities.
PMCID: PMC1242233  PMID: 16162279

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