Competency gap among graduating nursing students: what they have achieved and what is expected of them.

BACKGROUND: Nurses' professional competencies play a significant role in providing safe care to patients. Identifying the acquired and expected competencies in nursing education and the gaps between them can be a good guide for nursing education institutions to improve their educational practices. METHODS: In a descriptive-comparative study, students' perception of acquired competencies and expected competencies from the perspective of the Iranian nursing faculties were collected with two equivalent questionnaires consisting of 85 items covering 17 competencies across 5 domains. A cluster sampling technique was employed on 721 final-year nursing students and 365 Iranian nursing faculties. The data were analyzed using descriptive statistics and independent t-tests. RESULTS: The results of the study showed that the highest scores for students' acquired competencies and nursing faculties' expected competencies were work readiness and professional development, with mean of 3.54 (SD = 0.39) and 4.30 (SD = 0.45), respectively. Also, the lowest score for both groups was evidence-based nursing care with mean of 2.74 (SD = 0.55) and 3.74 (SD = 0.57), respectively. The comparison of competencies, as viewed by both groups of the students and the faculties, showed that the difference between the two groups' mean scores was significant in all 5 core-competencies and 17 sub-core competencies (P < .001). Evidence-based nursing care was the highest mean difference (mean diff = 1) and the professional nursing process with the lowest mean difference (mean diff = 0.70). CONCLUSION: The results of the study highlight concerns about the gap between expected and achieved competencies in Iran. Further research is recommended to identify the reasons for the gap between the two and to plan how to reduce it. This will require greater collaboration between healthcare institutions and nursing schools.

Cortical gray matter and cerebral white matter atrophy and asymmetry in Parkinson's disease patients with normal cognitive precede.

BACKGROUND: Parkinson's disease is the second most common neurodegenerative disorder with complex and distributed motor and non-motor symptoms. In this study, cortical gray matter (GM) and cerebral white matter (WM) overall atrophy, and asymmetry of atrophy are investigated in PD with normal cognitive function. METHOD: Forty-eight male Parkinson's disease(PD) patients with normal cognitive precede (PD-NC), and thirty matched healthy control (HC) subjects were selected from the Parkinson's Progression Markers Initiative (PPMI) database. Brain structures volumes were extracted using Freesurfer software based on subject 3 tesla MRI images. The normalized volume of cortical GM and cerebral WM were compared in two study groups, and then the asymmetry index (AI) of GM and WM atrophy was also assessed in two groups. Statistical analysis was constructed using a t-test with p < 0.05 of significance. RESULTS: No significant difference was observed in the volume of cortical GM and cerebral WM in the two study groups. The cortical GM asymmetry index in the PD-NC group was significantly (p = 0.01) higher than the HC group, however, no difference was observed for the cerebral WM asymmetry index. CONCLUSION: Atrophy in cortical GM and WM was not observed between the PD-NC and the HC group, however, the asymmetry index in GM was significant between the two group. It seems that the brain's bilateral balance has ruptured in PD. Cortical GM asymmetry in PD-NC can be considered a potent biomarker and should be investigated more in the future. In future studies, construction of a longitudinal study on this issue could be useful.

Cross-Cultural Adaptation and Psychometric Validation of the Interview Satisfaction Questionnaire (ISQ) to Assess Unmet Health Communication Needs of Iranian Breast Cancer Patients.

Autonomous and patient-centered health communication (PCHC) between a healthcare provider (HCP) and a client (HCC) is a critical fundament for successful healthcare outcomes. A standard and validated data collection tool for studying the satisfaction of Iranian breast cancer patients (BCPs) with various aspects of their health communication with HCPs does not exist. The current study assessed the application, feasibility, and cultural appropriateness of the Persian-translated version of the interview satisfaction questionnaire (ISQ) in the Iranian context. A standard translation/back-translation procedure was used to prepare a preliminary Persian version of the ISQ (ISQ-P) which was then evaluated for content and face validity by a panel of experts. The study data were collected from 200 breast cancer patients and used to estimate the internal consistency measure of Cronbach's alpha and intra-class correlation coefficient. Confirmatory factor analysis (CFA) was performed to verify the compatibility of the instrument's identified dimensions with the original ISQ's factor structure. The calculated content validity index (CVI = 0.89), content validity ratio (CVR = 0.49), and Cronbach's alpha coefficient (0.79) indicated the appropriateness of the ISQ-P for its intended purpose. The CFA's outputs (root mean square error of approximation (RMSEA) = 0.09, comparative fit index (CFI) = 0.954, Tucker-Lewis index (TLI) = 0.931, standardized root mean square residual (SRMR) = 0.04) affirmed the fitness of the study data to the original 4-factor conceptual model. The study findings supported the suitability of ISQ-P for assessing health communication episodes by Persian-speaking BCPs. However, due to cultural variation, cross-border diversity of health systems, and organizational circumstances, further validity and reliability appraisal of the ISQ-P in distinct sub-samples is recommended.

Exploring the relationships among safety leadership, safety climate, psychological contract of safety, risk perception, safety compliance, and safety outcomes.

Background: Recently, two types of safety compliance behaviors including deep compliance and surface compliance were differentiated. The current study aimed to investigate the relationships among safety leadership, safety climate, psychological contract of safety (PCS), risk perception, and deep compliance and surface compliance behavior of workers. In addition, the effects of both deep and surface compliance on safety outcomes were considered. Methods: Workers' perceptions in terms of safety leadership, safety climate, PCS, risk perception, deep compliance, and surface compliance were measured by appropriate questionnaires. Three questions were asked to measure undesired safety outcomes. Structural equation modeling and correlation analysis were applied to examine the research model and relationships among variables. Results and discussion: The results of the current study showed that deep compliance was positively predicted by safety leadership, safety climate, and PCS and negatively predicted by risk perception. Surface compliance was positively predicted by safety leadership and safety climate and negatively predicted by risk perception. Surface compliance is not significantly predicted by PCS. With regard to the adverse safety outcomes, the results showed that both deep and surface compliance were negatively associated with adverse safety outcomes, however, deep compliance had a stronger negative correlation with adverse safety outcomes than surface compliance.

Competencies expected of undergraduate nursing students: A scoping review.

AIM: Nursing competencies are crucial indicators for providing quality and safe care. The lack of international agreement in this field has caused problems in the generalization and application of findings. The purpose of this review is to identify the core competencies necessary for undergraduate nursing students to enter nursing work. DATA SOURCES: We conducted a structured search using Scopus, MEDLINE (PubMed), Science Direct, CINAHL, Web of Science, and Google Scholar. REVIEW METHODS: We conducted a scoping review using the methodology recommended by the Joanna Briggs Institute, supported by the PAGER framework, and guided by the PRISMA-ScR Checklist. Inclusion criteria included full-text articles in English, quantitative and qualitative research related to competencies for undergraduate students or newly graduated nurses, competency assessment, and tool development from 1970 to 2022. We excluded articles related to specific nursing roles, specific contexts, Master's and Ph.D. curricula, hospital work environment competencies, and editorial. RESULTS: Out of 15,875 articles, we selected 43 studies, and data analysis with summative content analysis identified five themes named individualized care, professional nursing process, nursing administration, readiness, and professional development. CONCLUSION: Considering the dynamics of competencies and their change with time, experience, and setting, it is necessary to update, localize, and levelling of the proposed competencies based on the culture of each country. IMPACT: These competencies provide a guide for undergraduate nursing curriculum development and offer a framework for both clinical instruction and the evaluation of nursing students.

Machine learning framework for atherosclerotic cardiovascular disease risk assessment.

Introduction: Atherosclerotic cardiovascular disease (ASCVD) is the first leading cause of mortality globally. To identify the individual risk factors of ASCVD utilizing the machine learning (ML) approaches. Materials & methods: This cohort-based cross-sectional study was conducted on data of 500 participants with ASCVD among Tabriz University Medical Sciences employees, during 2020. The data with ML methods were developed and validated to predict ASCVD risk with naive Bayes (NB), spurt vesture machines (SVM), regression tree (RT), k-nearest neighbors (KNN), artificial neural networks (ANN), generalized additive models (GAM), and logistic regression (LR). Results: Accuracy of the models ranged from 95.7 to 98.1%, with a sensitivity of 50.0 to 97.3%, specificity of 74.3 to 99.1%, positive predictive value (PPV) of 0.0 to 98.0%, negative predictive value (NPV) of 68.4 to 100.0%, positive likelihood ratio (LR +) of 13.8 to 96.4%, negative likelihood ratio (LR-) of 3.6 to 51.9%, and area under ROC curve (AUC) of 62.5 to 99.4%. The ANN fit the data best with an accuracy of 98.1% (95% CI: 96.5-99.1), a specificity of 99.1% (95% CI: 97.7-99.9), a LR + of 96.4% (95% CI: 36.2-258.8), and AUC of 99.4% (95% CI: 85.2-97.0). Based on the optimal model, sex (females), age, smoking, and metabolic syndrome were shown to be the most important risk factors of ASCVD. Conclusion: Sex (females), age, smoking, and metabolic syndrome were predictors obtained by ANN. Considering the ANN as the optimal model identified, more accurate prevention planning may be designed.

Optimizing ozone dose and contact time for removal of antibiotic-resistant P. aeruginosa, A. baumannii, E. coli, and associated resistant genes in effluent of an activated sludge process in a municipal WWTP.

This study aimed to investigate the impact of ozonation on inactivation of antibiotic-resistant bacteria (ARB) including E. coli, P. aeruginosa, and A. baumannii, as well as on removal of 16S-rRNA gene and their associated antibiotic-resistant genes (ARGs) indigenously present in effluent of municipal wastewater treatment plant. The Chick-Watson model was used to describe bacterial inactivation rates at specific ozone doses. Maximum reduction of total cultivable A. baumannii, E. coli, and P. aeruginosa were found to be 7.6, 7.1, and 4.7 log, respectively, with the highest ozone dose of 0.48 gO3/gCOD at 12 min contact time. According to the study results, complete inactivation of ARB and bacterial regrowth was not observed after 72 h incubation. The culture methods overestimated the performance of disinfection processes and propidium monoazide combined with qPCR, and showed the presence of viable but non-culturable bacteria after ozonation. ARGs were more persistent to ozone than ARB. The results of this study highlighted the significance of specific ozone dose and contact time in ozonation process considering the bacterial species and associated ARGs as well as the wastewater physicochemical characteristics, in order to help diminish the entrance of the biological microcontaminants into the environment.

Survey of the Relationship between Extroversion and Transition in Cigarette and Hookah Smoking Stages in High-School Students in Tabriz: A Longitudinal Study.

Background: Smoking is a public health problem that affects the adolescent population's health. This study aimed to investigate the relationship between extroversion (compared with introversion) and transition in cigarette and hookah smoking stages in high-school students to use the results in smoking prevention programs. Methods: A sample of 2312 students aged 15-16 years in Tabriz were included in the study. Demographic characteristics, cigarette, hookah smoking status, and Eysenck's extroversion questionnaires were completed by all students in the selected schools. Eight months later, cigarette and hookah smoking status were assessed again to determine transition in smoking stages. The marginal homogeneity (MH) test was used to compare the smoking status at the beginning and 8 months later. The generalized estimating equation (GEE) method with the ordinal link was applied to estimate the effect of extroversion on transition in smoking stages. Results: The mean (standard deviation) age of the students participating in the study was 15.5 (0.5) years. MH test results showed that, in general, transmission in the stages of both cigarette and hookah smoking in 8 months was significant in students (P-value < 0.0001). Extrovert personality had a significant positive effect on the transition from lower stages to higher cigarette and hookah smoking stages according to the GEE with ordinal link (P = 0.01). In cigarette and hookah smoking, extrovert persons transited to higher stages 1.64 and 1.55 times more than introvert persons. Conclusions: Being an extrovert person had a significant effect on the transitioning to higher stages of smoking cigarettes and hookah. In designing cognitive programs to prevent people from smoking or encourage them to quit smoking, considering this dimension of personality trait can be useful in the efficacy of the program.

Tracking microplastics contamination in drinking water in Zahedan, Iran: From source to consumption taps.

Microplastics (MPs) that pollute drinking water are inherently toxic, act as an adsorbent of hazardous pollutants, and threaten human health. So, the fate of microplastics in drinking water from the source to consumption taps (CTs) was assessed in spring and winter in Zahedan city in Iran. Sampling was performed from 4 reservoirs (raw water), before and after two water treatment plants (WTPs), and 10 CTs. The reservoirs were sampled using a plankton net (pore size = 100 µm), and the remaining samples were taken using a sampling device (containing a stainless steel membrane as a filter with pore size = 5 µm). The combination of density separation techniques, digestion, observation, Micro-Raman and FTIR, and SEM analysis was performed to recognize MPs. The average number of MPs in raw water varied between 15.4 and 44.7 MP/m3 (winter) and 22-51.8 MP/m3 (spring). The results before and after the treatment plant showed that about 64 % and 75 % of particles were eliminated in WTP1 and WTP2, respectively. The average number of MPs in CTs was more than treatment water (CTa = 85-390 MP/m3 and CTb = 75-400 MP/m3), which is a probable confirmation of secondary contamination (abrasion from pipes, installations, and sealing materials). The dominant type of polymer detected in raw water, treated water, and consumption taps were PS. The estimated daily intake for children and adults was about 0.16-15 MP/kg/bw/year and 0.07-5.7 MP/kg/bw/year, respectively. The surface morphology of MPs showed that the particles were affected by continuous weathering, mechanical breakage, and oxidation. MPs threaten the environment and human health due to the adsorption and transport of hazardous pollution and their intrinsic toxicity, so a solution must be thought of to prevent the pollution of drinking water by MPs.

Moral awareness and its relationship with moral sensitivity among Iranian nursing students: A basis for nursing ethics education.

AIM: This descriptive-analytical correlational study was carried out to examine moral awareness and its relationship with moral sensitivity among Iranian nursing students. DESIGN: A descriptive-analytical correlational study. METHODS: The present descriptive-analytical study was performed among 140 Iranian nursing students. The data collection tool was a three-part questionnaire including (1) Demographic Information Questionnaire, (2) Nurses' Awareness about the Iranian Nursing Code of Ethics by Mohajjel Aghdam and (3) Moral Sensitivity Questionnaire (MSQ) by Kim Lutzen. The data collected from these questionnaires were analysed in SPSS-26 using descriptive and inferential statistics. RESULTS: The mean moral awareness (29.42 ± 4.01) was good, and the mean moral sensitivity (135.05 ± 18.79) was moderate among the students. A significant positive correlation was observed between the total score of moral awareness and moral sensitivity (r = .22, p = .009) in the nursing students.

Comparison of the Iranian and Scandinavian bachelor of nursing curriculum (Sweden): A scoping review.

BACKGROUND: The comparison of the educational curriculum improves the content and quality of the curriculum and needs to be revised and modified in line with the current needs of society. Development of nursing knowledge, the emergence of emerging diseases requires that the nursing curriculum be codified and provide the necessary skills to provide quality and safe care. MATERIALS AND METHODS: The study aimed to Comparison of Iranian and Scandinavian Bachelor of Nursing Curriculum (Sweden). This descriptive-comparative study was conducted based on the Bereday model in four stages: Description, Interpretation, Juxtaposition, Comparison, and Analysis in 2022. We use relevant electronic databases such as PubMed, CINAHL, Web of Science, Iran Medex, SID, Magiran, Google Scholar, Iran Doc, and Science Direct databases. RESULTS: The results showed that despite the similarities, the Swedish nursing curriculum had special features in most of the mentioned dimensions. Including decentralized admission, Fits the need, competency-based curriculum, attention to holistic care and intercultural care, use of new digital technologies in education, and clinical training and evaluation. CONCLUSION: It seems that the Iranian nursing curriculum is far from the mentioned perspective. Using the experiences of the world's top universities, such as Sweden, can improve the quality of nursing undergraduate programs and improve the nursing profession by eliminating current shortcomings.

Risk assessment of physical unit operations of wastewater treatment plant using fuzzy FMEA method: a case study in the northwest of Iran.

Failure Mode and Effects Analysis (FMEA) is one of the most used methods in risk assessment and prioritization. This study was conducted to identify, evaluate, prioritize, and analyze risks associated with the physical processes of Sahand municipal wastewater plant using traditional and fuzzy FMEA methods. The present research was a cross-sectional analytical study that was conducted to prioritize the risks of unit operations of screening and grit removal in Sahand municipal wastewater treatment plant for 6 months. First, a team of five experts was formed and the traditional FMEA worksheet was completed. Then, the fuzzy membership functions were determined according to experts' opinions and using the MATLAB program, and the severity, occurrence, detection, and risk priority number (RPN) became fuzzy and risks were prioritized according to the fuzzy logic outputs. A total of 53 failure modes were identified for screening (26 failures) and grit removal units (27 failures) using the traditional FMEA risk assessment technique. The results of the traditional FMEA method showed that among the 53 identified failure modes, in physical treatment equipment of Sahand municipal wastewater, 51 failures (96.2%) were in the low-risk levels and two failures (3.8%) were in the medium-risk levels. According to the results of the fuzzy FMEA, 5 failures (9.4%) were in the low-risk levels, 43 failures (81.2%) were in the medium-risk levels, and 5 failures (9.4%) were in the high-risk levels. Based on the traditional FMEA, the highest and lowest level of risk belonged to manual screening clogging and conveyor cutting of mechanical screening with RPN of 540 and 12, respectively, whereas in the fuzzy FMEA, the highest and lowest level of risk were related to manual screening clogging and fracture of pump pipes with RPN of 894 and 105, respectively. The finding showed that risk assessment using fuzzy FMEA provides more accurate and better results than traditional FMEA. In the fuzzy FMEA, the involvement of the experts' opinions in risk assessment and fuzzy models leads to more realistic results, as well as corrective action prioritization is better performed.

Characterization of antibiotic resistance genes and bacteria in a municipal water resource recovery facility.

Municipal water resource recovery facilities (WRRFs) are important sources of antibiotic-resistant bacteria and genes (ARB and ARGs). In this study, antibiotic-resistant total heterotrophic bacteria (THBR ) counts (CFU/ml) cultivated from influent, effluent of activated sludge process, and outflow of disinfection unit of an urban WRRF were investigated for the presence of 16, 32, 64, and 128 µg/ml of nine antibiotics. The isolates of Pseudomonas spp., Acinetobacter spp., and Escherichia coli obtained from effluent of activated sludge process were subjected for molecular identification by detecting the 16S rRNA gene sequences. Additionally, using the polymerase chain reaction method (PCR), the isolates were investigated for the presence of blaSHV , blaTEM , blaCTX-M , blaVIM , sul1, and qnrS genes. According to the results, the abundance of THBR counts was not significantly reduced by the biological treatment except for cefixime and sulfamethoxazole; it also increased for some antibiotics after disinfection unit. The average removal efficiency of THBR resistant to ciprofloxacin, sulfamethoxazole, and ceftazidime were 7.9 ± 1.7%, 41.8 ± 2.1%, and 14.4 ± 6.2%, respectively. Also, all the tested isolates were resistant to at least four antibiotics. For all antibiotics, the resistance ratio (THBR /THB) significantly increased in the effluent and after chlorination unit. Among 12 resistant isolates, blaTEM and sul1 genes were the most frequently detected ones involved in 92% and 83% of the isolates, respectively. Both blaTEM and sul1 genes were found in 100% of E. coli, and 83% and 67% of Pseudomonas spp. isolates, respectively. Further efforts are necessary to limit the transmission of ARB and ARGs from WRRFs into the environment and prevent human health threats. PRACTITIONER POINTS: The ratio of resistance significantly increased after biological treatment. Up to 40% of heterotrophic bacteria in the effluent was antibiotic resistant. blaTEM and sul1 genes were more prevalent (92%) in all isolates of bacteria. Both blaTEM and sul1 genes were found in 100% of E. coli isolates. Pseudomonas spp. holds blaTEM and sul1 genes in 83% and 67% of isolates, respectively.

Relationships between ethical decision-making and professional behavior in Iranian nursing students.

Ethical decision-making and professional behavior are essential skills in nursing profession, hence educational programs should be designed to enable future nurses to tackle problems related to ethical decision-making. This descriptive, correlational and analytical study aimed at determining the ability of Iranian nursing students to make ethical decisions as well as relationship between such decisions and professional behavior. The present study used census to select 140 freshmen from the School of Nursing and Midwifery of Tabriz University of Medical Sciences, Tabriz, Iran. Data collection tools included a demographic questionnaire, the Nursing Dilemma Test (NDT) comprising two indices of "nurse's principled thinking" and "practical consideration", as well as the Nursing Students Professional Behaviors Scale (NSPBS).

Applying count time series to assess 13-year pedestrian mortality trend caused by traffic accidents in East-Azerbaijan province, Iran.

In populated cities, pedestrian mortality is higher compared to other traffic mortalities. The current study aimed to describe the trend of pedestrian mortality in the East-Azerbaijan (Northwest of Iran) province from 2006 to 2019 and find the factors that affect the mortality number. Pedestrian mortality data from March 2006 to March 2019 was obtained from the Legal Medicine Organization database of Iran. Generalized Linear Auto Regressive Moving Average (GLARMA) models were used to assess the trend, and affecting factors of pedestrian mortality. According to the traffic accident data from 21 March 2006 until 20 March 2019 in East-Azerbaijan 24.11% of mortalities are related to pedestrians. Pedestrian mortality had a decreasing seasonal trend during 2006-2019. The result of the GLARMA model showed that age >65, being non-educated, cases with head trauma death cause, pre-hospital death, accident inside the city, vehicle type and self-employed jobs had a direct relation to pedestrian's mortality.

Traffic climate, driver behaviour and dangerous driving among taxi drivers.

Traffic accidents are considered a major public health problem in many countries. The aim of this study was to explore the relationships between traffic climate factors (i.e., external affective demands, functionality and internal requirements), driver behaviours, dangerous driving behaviours and traffic accident involvement among taxi drivers. A total of 450 male taxi drivers participated in the study. The traffic climate scale (TCS), the driver behaviour questionnaire (DBQ), the positive driver behaviours scale (PDBS) and the Dula dangerous driving index (DDDI) were used to measure driving behaviours and traffic conditions. The results showed that there was a significant negative correlation between functionality (of the TCS) and the number of accident involvement. Further analysis demonstrated that the effect of risky driving (of the DDDI) on accident involvement was significant. Taken together, these findings suggest that functional traffic systems and driving environments play important roles in traffic accident involvement.

Contamination of the Caspian Sea Southern coast sediments with microplastics: A marine environmental problem.

Marine ecosystem pollution with microplastics (MPs) is a global problem. The current study aimed to assess the occurrence of MPs in the sediments of the Caspian Sea southern coasts. For sampling, two distinct areas were selected including recreational-tourism areas (No = 24), and non-tourist areas (No = 24). MPs were studied in 5 and 5-15 cm from the top sediment surface. All 96 samples were taken and analyzed according to the methodology provided by the US national oceanic and atmospheric administration (NOAA). The combination of observational techniques, FTIR, and SEM analysis was applied to identify MPs. MPs were classified into two categories in terms of size: small MPs and large MPs. The average, maximum, and minimum abundance of MPs (based on dry weight) in sediments of the southern coast of the Caspian Sea was 183.5 ± 154.4 MP/kg, 542 MP/kg, and 13 MP/kg, respectively. On the basis of morphology, fragment-shaped (30.3%) MPs showed the highest prevalence, while film-shaped (18.7%) MPs were the least contributory. Polyethylene (PE) and polyethylene terephthalate (PET), each of them with a 20% share, were the most common MPs found in the studied samples. The distribution of MPs on the southern coasts of the Caspian Sea revealed a sporadic and irregular spatial pattern. Correspondingly, it can be concluded that probably environmental factors (the current of the sea surface water from west to east), enclosed environment of the Caspian Sea, anthropogenic activities (e.g., industrialization and urbanization, improper waste management, fishing, and tourism activity, residential wastewater), and also discharging of rivers (which can carry plastics) into the sea, have all influenced the abundance and polymer diversity of MPs in the sediments of the southern coast of the sea. More attention should be paid to the health and environmental effects of MPs and to the protection of this sensitive marine ecosystem through implementing proper waste management system by all surrounding littoral countries.

Estimation of plastic waste inputs from land into the Caspian Sea: A significant unseen marine pollution.

It has been proven that there is an extensive bulk of plastic debris in marine ecosystems. The present study analyzed solid waste generation, its management and final disposal methods in Caspian Sea coastal countries, and the amount of plastic waste entering the Caspian Sea. The results showed that, on average, more than 90% of waste in the Caspian Sea coastal countries is mismanaged. According to our estimates, 425 kilotons (Kt) of plastic waste was generated by Caspian Sea coastal countries in 2016, of which, with high probability, 58-155 Kt find their way to the Caspian Sea. It is estimated that without improved waste management infrastructures, the amount of plastic waste entering the Caspian Sea will increase to 68-182 Kt by 2030, an increase of about 15%. Accordingly, the related cumulative environmental and health problems could be more severe. All countries located in the coastal areas of the Caspian Sea should revise their solid waste and plastic waste management programs to protect that sensitive marine ecosystem.

Comparison Between Effects of Home Based Cardiac Rehabilitation Programs Versus Usual Care on the Patients' Health Related Quality of Life After Coronary Artery Bypass Graft.

BACKGROUND & AIM: To compare home-based cardiac rehabilitation with usual care on the patients' Health Related Quality of Life (HRQoL) after coronary artery bypass graft in patients with coronary artery bypass graft (CABG) surgery. METHODS: In a randomized controlled clinical conducted from March 2013 to June 2013, 110 patients with CABG surgery were randomly assigned into two groups. While patients in group I, were received usual care and patients in group II, in addition to the usual care were received home-based cardiac rehabilitation programs. The 27-item MacNew Heart Disease HRQoL questionnaire was used to evaluate the patient's HRQoL under and over 2 months after intervention. RESULTS: At the time of 0, mean score of HRQoL was 67.86±7.5 and 64.76±8.4 in patients in group I and group II, respectively (P> 0.05). Although mean score of HRQoL in all patients in both groups increased two month after intervention, but this increase in patients in group II were higher than patients in group I (154.93±4.6 vs 134.20±8.2). This difference were statistically significant (P< 0.05). CONCLUSION: Quality of Life (QoL) can be considered as a quality indicator of health care systems. Results of present study showed that home-based cardiac rehabilitation program improved patients HRQoL after CABG surgery.

Risk Score Model for Predicting Sonographic Non-alcoholic Fatty Liver Disease in Children and Adolescents.

OBJECTIVE: This study aimed to develop and test the validity of a risk score to be used as a simple tool to identify those children at high risk of sonographic non-alcoholic fatty liver disease (NAFLD). METHODS: This cross-sectional study was conducted among 962 participants aged 6-18 years in Isfahan, Iran. They consisted of three groups of nearly equal number of normal-weight, overweight and obese individuals. Coefficients of the logistic regression models were used to assign a score value for each variable and the composite sonographic NAFLD risk score was calculated as the sum of those scores. Performance of model was assessed by receiver operating characteristic (ROC) curve procedure. FINDINGS: Data of 931 participants was included in the analysis. The sonographic findings of 16.8% of participants were compatible with NAFLD. Age, sex, body mass index, waist circumference and serum triglycerides level were diagnosed as factors associated with NAFLD. The risk score was calculated as 50 for sonographic NAFLD. CONCLUSION: This study, to the best of our knowledge is the first of its kind in the pediatric age group, focuses on predicting sonographic NAFLD from easily-measured factors. It may suggest an association of hypertriglyceridemic-waist phenotype with NAFLD in the pediatric age group.