Prognostic factors of survival time after hematopoietic stem cell transplant in acute lymphoblastic leukemia patients: Cox proportional hazard versus accelerated failure time models

<p>Abstract</p> <p>Background</p> <p>The aim of this study is to evaluate the prognostic factors of overall survival (OS) after haematopoietic stem cell transplant (HSCT) in acute lymphoblastic leukaemia (ALL) patients using accelerated failure time (AFT), Cox proportional hazard (PH), and Cox time-varying coefficient models.</p> <p>Methods</p> <p>206 patients were enrolled after HSCH in Shariati Hospital between 1993 and 2007. There was evidence of marked departures from the proportional hazards assumption with two prognostic factors, relapse and chronic graft-versus-host disease (cGVHD) (P < .001). Performance among AFT and Cox's models was assessed using explained variation and goodness of fit methods. Discrimination among the exponential, Weibull, generalized gamma (GG), log-logistic, and lognormal distributions was done using maximum likelihood and Akaike information criteria.</p> <p>Results</p> <p>The 5-year OS was 52% (95%CI: 47.3–56.7). Peak mortality hazard occurred at months 6–7 after HSCT followed by a decreasing trend. In univariate analysis, the data was better fitted by GG distribution than by other distributions. Univariate analysis using GG distribution showed a positive association between OS with acute graft-versus-host disease (aGVHD) (P = .021), no relapse (P < .001), cGVHD (P < .001), neutrophil recovery (P < .001) and platelet recovery (P < .001). Based on Cox PH models; however cGVHD and relapse were the predictive factors of OS (P < .001). Multivariate analysis indicated that, OS is related to relapse (P < .001) and platelet recovery (P = .037), where predictive power of Weibull AFT models was superior to Cox PH model and Cox with time-varying coefficient (R²= 0.46 for AFT, R²= .21 for Cox PH and R²= .34 for Cox time-varying coefficient). Cox-Snell residual shows Weibull AFT fitted to data better than other distributions in multivariate analysis.</p> <p>Conclusion</p> <p>We concluded that AFT distributions can be a useful tool for recognizing prognostic factors of OS in acute lymphoblastic leukemia patients.</p

Comparison of Onset Age and Pattern of Male Adolescent Smoking in Two Different Socioeconomic Districts of Tehran, Iran

Objectives: One of the main strategies to prevent smoking is delaying onset of smoking in adolescents. Thus, identifying the age of smoking and smoking pattern in adolescents gives important knowledge for planning the intervention programs on smoking. Methods: Students aged 13-15 years old living in the Northern and the Southern Tehran were selected through two separate snowball samplings. In each area six smokers were considered as the seeds and were asked to introduce a smoker friend. The sampling continued until one hundred study subjects were recruited in each area. Results: Although in the area with wealthier socioeconomic status the age at which smoking started was one year more, the number of days of smoking, number of consumed cigarettes, not willingness to quit smoking, ease of access to cigarettes, mother and siblings smoking were more frequent. In contrast, seeing anti-smoking advertisements, father smoking, teachers smoking and education about the adverse effects of smoking were lower than the area with poorer socioeconomic status. Conclusions: The community level interventions such as not selling cigarettes to juniors, quit smoking help and support, and education of families must be revised. The role of families, through the supervision and control over their children, and parents′ avoidance of smoking should be emphasized

What are differences between non-injecting and injecting drug addicts?

Background: This study aims to identify the differences between Injecting Drug Users (IDUs) and non-IDUs, with regard to some potential factors. This could be useful to design effective interventions for harm reduction, which is one of the priority areas in reducing the burden of addiction. Methods: Sixty cases and 60 controls participated in this pair-matched case-control study, which was conducted in Tehran. The cases were IDUs who were asked to introduce two friends; one IDU and the other non-IDU as the paired control. In addition to demographic variables, onset age of cigarette smoking, dropping out of school, imprisonment, history of being sexually abused for money, and family history of using illegal drugs were obtained from the cases and controls via an interview. Pair Odds Ratio (OR) was estimated through McNemar and conditional multivariable logistic regression analysis. Results: Eighty-three % of the IDUs and 92% the controls were male. The mean for onset age of cigarette smoking was 16 in the cases and 20 in the controls, which was significantly different between cases and controls (P<0.001). In the multivariate analysis, dropping out from school was significantly different between cases and controls (OR=4.22 95% CI: 2.23 - 14.0). Imprisonment was more frequent in IDUs compared to non-IDUs (OR=3.70 95% CI: 1.09 - 11.08). The cases had more sexual relationship for earning money compared to the controls (OR=3.14 95% CI: 1.24 - 13.70). Onset age of cigarette smoking was significantly (P<0.001) sooner in the IDUs compared to the non-IDUs (15.9 and 20.1 years, respectively). IDUs reported 5.5 times more that non-IDUs of having an addict in their family (P value=0.04). Conclusion: The finding of this study can be useful in identifying the persons who are at risk of IDU. Therefore, people who involve with risk factors recognized in this study should be triggered for harm reduction prevention strategies

Effects of oral magnesium supplementation on inflammatory markers in middle-aged overweight women

Background: This study aimed to investigate whether magnesium supplementation might affect serum magnesium, high sensitive C-reactive protein (hs-CRP), plasma fibrinogen, and interleukin 6 (IL-6) levels in healthy middle-aged overweight women. The relationships, if any, between serum magnesium and the inflammatory markers were also examined cross-sectionally in the entire participants at the beginning of the study. Materials and Methods: This double-blinded, placebo-controlled, randomized trial included 74 middle-aged overweight women. Participants were randomly assigned to receive either 250 mg magnesium as magnesium oxide or placebo daily for 8 weeks. Serum magnesium, hs-CRP, fibrinogen and IL-6 concentrations were measured before and after the intervention. Results: Serum magnesium was found to be inversely correlated with hs-CRP (r s =−0.22, P=0.05) in the entire participants at baseline. Serum hs-CRP declined significantly in both groups as compared with baseline values (median change=0.8 mg/L; P Magnesium= 0.03, P Placebo 0.001). Plasma fibrinogen decreased significantly, by 9%, in the magnesium group at the end of week 8 compared to baseline (P=0.001). Mean concentration of IL-6 was significantly increased in the magnesium group comparing the baseline value(P=0.001). However hs-CRP, fibrinogen and IL-6 levels at week 8 or any changes during the study were not statistically different between the two groups. Serum magnesium showed no significant changes in any groups. Conclusions: Serum magnesium had a significant inverse correlation with hs-CRP. In the present study, magnesium as magnesium oxide, 250 mg/day, for 8 weeks did not significantly attenuate inflammatory markers in the magnesium group as compared to the placebo

Reasons for Smoking Among Male Teenagers in Tehran, Iran: Two Case-Control Studies Using Snowball Sampling

Objectives: Identifying the underlying factors contributing to smoking among teenagers is important in establishing smoking control programs. The present study was designed to identify and compare factors revealed in a preceding qualitative study conducted on 13-15 year-old boys living in two different socioeconomic districts in the Northern and Southern parts of Tehran. Methods: Two completely similar case-control studies, each with 200 subjects, were conducted using a snowball sampling. The case and control subjects were matched based on the intimacy relations, i.e. six smokers were recruited in each of the Northern and Southern districts; they were then asked to introduce one of their smoker friends as a case and a non-smoker one as a control. Results: Multi-variable conditional logistic regression revealed that having a smoker father is the single effective factor in the two districts. As for boys living in the Northern (wealthier) part of the city, social capital (OR: 0.59, 95 CI: 0.43-0.81) played a protective role against smoking, whereas quitting home after a quarrel (OR: 15.07, 95 CI: 1.54-147.25), monthly allowance (OR: 2.22, 95 CI: 1.29-3.82) and hyperactivity (OR: 1.69, 95 CI: 2.64- 240.45) were associated with a higher risk of becoming a smoker. Conclusions: The studied variables can be classified as personal, familial, and school-level factors. Familial intervention is effective for all the factors which revealed to be influential on the risk of becoming a smoker. It could be concluded that interventions on the family level should be used to prevent the cigarette use in Tehran

Development of a Caregiver Burden Questionnaire for the Patients with Dementia in Iran

Objectives: The purpose of this study was to design a valid questionnaire suitable to the Iranian culture to measure the stress mounted on dementia caregivers. Methods: In order to design a valid and reliable tool, the stages of content validation were performed as follows: 1- Development: search of relevant electronic databanks and use of experts and caregivers′ opinions to prepare appropriate content, review and correction of the content through consecutive focus group discus-sions with experts. 2- Judgment Quantification: determination of inter-rater agreement (IRA), relevancy and clarity of each of the items and the tool as a whole. Reliability was measured with Cronbach′s alpha, and repeatability was measured with intra-cluster correlation through repeated test-piloting at 2-3 week in-tervals. Results: Using a conservative approach, the IRA for the overall relevancy and clarity of the tool was 87.87% and 81.81%, respec-tively. Through overall agreement (the items that were recognized as appropriate by 100% of the specialists were divided by the total number of items) the overall relevancy of the tool obtained was 98.62%. The overall clarity of the tool was calculated through the mean clarity of the questions and was 99.3%, and eventually its comprehensiveness was 100%. The overall Cronbach′s alpha was 94% and the intra-cluster correlation that was obtained through comparing the overall score of the questionnaire in the pre-test and test phase was 97%. Conclusions: The new tool has good reliability and validity suit-able to Iranian dementia patients and their caregivers′ culture. Researchers can use this tool to monitor the pressure mounted on dementia caregivers and to assess interventions in this group

Efficacy of folate and vitamin B₁₂in lowering homocysteine concentrations in hemodialysis patients

To evaluate the efficacy of supplementation with high dose folic acid with and with-out vitamin B 12 in lowering plasma total homocysteine (tHcy) concentrations in hemodialysis (HD) patients, we studied 36 HD patients randomized into four groups according to the received thera-peutic regimen: group I (only folic acid (FA), 5 mg/day), group II (FA, 5 mg/day &#x002B; vitamin B 12 , 1 mg/day) group III (only FA, 15 mg/day), group IV (FA, 15 mg/day, vitamin B 12 , 1 mg/day) for a period of 8 weeks. Plasma tHcy and serum FA and vitamin B 12 levels were measured at baseline and after the supplementation period. Dietary intakes were assessed during the study period. At baseline, 27.8&#x0025; of the patients had normal levels of tHcy and 72.2&#x0025; had hyperhomocysteinemia. After supplementation, plasma tHcy increased by 1.35&#x0025; in group I and decreased by 6.99&#x0025;, 14.54&#x0025; and 30.09&#x0025; in groups II, III and IV respectively, which was only significant in group IV (P= 0.014). The patients did not show any significant changes in serum folic acid, but a significant change in serum vitamin B 12 in group IV (P= 0.006). Percentage of patients reaching normal levels of plasma tHcy was 5.6 fold higher in group IV than in the reference group (group I). No corre-lations were found between changes of plasma tHcy levels and dietary intakes. We conclude that oral supplementation with 15 mg/day folic acid together with 1 mg/day of vitamin B 12 is effective in reducing tHcy levels in HD patients. These supplements also have a desirable effect on serum folic acid and vitamin B12