Demographic characteristics and mental health condition of Tehran Municipality employees during the COVID-19 pandemic

BACKGROUND

Coronavirus disease 2019 (COVID-19) has become a global health issue with various effects on the physical and mental state of the societies. The aim of this study was to identify the demographic characteristics and mental health condition of Tehran Municipality employees during the COVID-19 pandemic.

METHODS

This cross-sectional study was performed on Tehran Municipality employees in 2020-2021. Participants were selected using stratified random sampling and were divided into COVID-19 and uninfected groups. Demographic characteristics, COVID-19 risk behaviors, General Health Questionnaire-28 (GHQ-28), and Well- Being Social Inventory were filled for all participants.

RESULTS

A total of 510 participants (363 uninfected participants and 147 participants with COVID-19) were evaluated. The prevalence of female gender was significantly higher in COVID-19 group compared to uninfected group (p < 0.001). There was a significant difference between groups in terms of education level (p < 0.001), prevalence of excess weight (p < 0.001), and working sector (p < 0.001). The uninfected group mainly had low contact with clients (p < 0.001) and few underlying diseases (p = 0.004) compared to the COVID-19 group. The mean GHQ-28 and Well- Being Social Inventory were significantly higher in the uninfected group compared to the COVID-19 group (p = 0.002 and p < 0.001, respectively). The prevalence of no and low contact level was significantly higher in the high infection cluster compared to moderate and low infection clusters (p = 0.024).

CONCLUSIONS

The findings of this study indicated that all workers should be educated about the significance of social distancing and follow the recommendations regardless of their level of contact with clients.

The impact of covid-19 pandemic on pregnancy outcome

BACKGROUND

The acute respiratory disease caused by the coronavirus (COVID-19) has spread rapidly worldwide yet has not been eliminated. The infection is especially deadly in vulnerable populations. The current studies indicate that pregnant women are at greater risk of getting seriously ill. Even though fetuses protect against disease, the additional finding showed that the COVID-19 pandemic could increase fetal and maternal morbidities. In a situation where COVID-19 and new strains of the virus are still not controlled, scientists predicted that the world might experience another pandemic. Consequently, more research about the effects of COVID-19 infection on pregnancy outcomes is needed. This study aimed to compare the pregnancy outcomes of Iranian pregnant women in the first year of the pandemic with the previous year.

METHODS

This prospective cross-sectional study was performed to compare the pregnancy outcome during the COVID-19 pandemic among Iranian pregnant women who gave birth during the pandemic and one year before the pandemic (2019-2020 and 2020-2021). The sample size was 2,371,332 births registered at hospitals and birth centers platforms. The studied variables include stillbirth, congenital anomaly, birth weight, preeclampsia, gestational diabetes, cesarean section, ICU admission, mean of the gestational age at birth, preterm births, NICU admission, neonatal mortality and the percentage of deliveries with at least one complication such as blood transfusion and postpartum ICU admission. Analyzing data was done by using SPSS version 25 software.

RESULTS

We found statistical differences between pregnancy and birth outcomes during the COVID-19 pandemic compared to one year before. The risk of preeclampsia, gestational diabetes, cesarean section, preterm birth and NICU admission were clinically significant. Also, there was a significant decrease in mean gestational age.

CONCLUSION

The COVID-19 pandemic has affected the pregnancy outcome by increasing morbidities and complications during pregnancy, birth, and postpartum. In addition, extensive quarantine outbreaks disrupted the healthcare system and hindered access to prenatal services. It is necessary to develop preventive and therapeutic care protocols for similar pandemic conditions.

A117 VALIDITY EVIDENCE FOR ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY COMPETENCY ASSESSMENT TOOLS: A SYSTEMATIC REVIEW

Background

Assessment of competence in endoscopic retrograde cholangiopancreatography (ERCP) is essential to ensure trainees possess the skills needed for independent practice. Traditionally, ERCP training has used the apprenticeship model, whereby novices learn skills under the supervision of an expert. A growing focus on procedural quality, however, has supported the implementation of competency-based medical education models which require documentation of a trainee’s competence for independent practice. Observational assessment tools with strong evidence of validity are critical to this process. Validity evidence supporting ERCP observational assessment tools has not been systematically evaluated.

Purpose

To conduct a systematic review of ERCP assessment tools and identify tools with strong evidence of validity using a unified validity evidence framework

Method

We conducted a systematic search using electronic databases and hand-searching from inception until August 2021 for studies evaluating observational assessment tools of ERCP performance. We used a unified validity framework to characterize validity evidence from five sources: content, response process, internal structure, relations to other variables, and consequences. Each domain was assigned a score of 0-3 (maximum score 15). We assessed educational utility and methodological quality using the Accreditation Council for Graduate Medical Education framework and the Medical Education Research Quality Instrument, respectively.

Result(s)

From 2769 records, we included 17 studies evaluating 7 assessment tools. Five tools were studied for clinical ERCP, one on simulated ERCP, and one on simulated and clinical ERCP. Validity evidence scores ranged from 2-12. The Bethesda ERCP Skills Assessment Tool (BESAT), ERCP Direct Observation of Procedural Skills Tool (ERCP DOPS), and The Endoscopic Ultrasound (EUS) and ERCP Skills Assessment Tool (TEESAT) had the strongest validity evidence with scores of 10, 12, and 11, respectively. Regarding educational utility, most tools were easy to use and interpret, and required minimal additional resources. Overall methodological quality was strong, with scores ranging from 10-12.5 (maximum 13.5).

Conclusion(s)

The BESAT, ERCP DOPS, and TEESAT have strong validity evidence compared to other assessments. Integrating tools into training may help drive learners’ development and support competency decision-making.

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CAG

Disclosure of Interest

None Declared

A25 CRITICAL APPRAISAL OF GI ENDOSCOPY CLINICAL PRACTICE GUIDELINES DURING THE COVID-19 PANDEMIC

Background

Clinical Practice Guidelines (CPGs) are integral during a pandemic, offering guidance to clinicians through uncertainty. Existing literature has established that the need for rapid publication of CPGs during previous infectious disease outbreaks resulted in less rigorous guidelines. CPGs were rapidly developed since the onset of the pandemic in December 2019, providing guidance in gastrointestinal (GI) endoscopy, an area where COVID-19 may pose risk of transmission.

Aims

To evaluate the quality of GI endoscopy guidelines developed during the COVID-19 pandemic and to compare these with (a) endoscopy CPGs developed prior to the pandemic; (b) CPGs for other endoscopic topics unrelated to COVID-19; and, (c) non-endoscopic CPGs published during the pandemic.

Methods

We systematically searched Medline, Embase and Scopus for CPGs published by GI societies from January 1, 2018 to December 31, 2020. A grey literature search was conducted. Two authors screened full-texts. In this interim analysis, CPGs were grouped based on publication year: before 2020, or 2020. Endoscopy CPGs published in 2020 were categorized as COVID or non-COVID related. Two authors independently assessed the CPGs using the AGREE II tool, consisting of six domains for evaluating guidelines. A domain score of 60 was set as a threshold to indicate good quality.

Results

There were 70 endoscopy guidelines and 27 CPGs focused on other GI topics. The mean overall scores were 69% (±12%) for endoscopy CPGs published before 2020 (n=28), and 51% (±23%) for CPGs published in 2020 (n=42). For individual AGREE II domains, mean scores for pre-2020 CPGs ranged from 33.11 (±17.39) in Applicability to 81.55 (±10.37) in Clarity of Presentation. For CPGs published during COVID-19, mean domain scores ranged from 34.18 (±10.52) in Applicability to 75.26 (±13.85) in Clarity of Presentation. 21 of 42 CPGs published in 2020 were related to COVID. Mean overall scores were 35% (±20%) for COVID-related CPGs and 67% (±13%) for non-COVID-19 CPGs. For COVID-19 CPGs, scores ranged from 27.88 (±20.31) in Rigour of Development to 69.58 (±10.81) in Scope and Purpose. For non-COVID CPGs, the scores ranged from 37.30 (±8.93) in Applicability to 84.52 (±5.93) in Clarity of Presentation.

Conclusions

The difference in overall scores between COVID-19 endoscopy CPGs and non-COVID endoscopy CPGs may suggest that the urgency to disseminate COVID-19 information decreased CPG quality or completeness of reporting. This interim analysis is limited by the lack of distinction between peer-reviewed CPGs and non-peer reviewed recommendations. Given the importance of CPGs in clinical decision making, it is important to ensure that the rapid development of guidelines does not compromise quality and rigour.

Funding Agencies

None

Sustainable Farming Practices, Awareness, and Behavior in Small Farms in Brazil

This paper investigates the relationship between the use of digital and non-digital sources of information on sustainable farming practices, institutional pressure and adoption of such practices by farmers in Brazilian semi-arid lands. The research uses a model based on the theory of reasoned action (TRA) and the institutional theory. Our results for a sample of 100 Brazilian farmers show that non-digital sources of information and ‘Coercive’ and ‘Normative’ pressures have a positive impact on farmers’ attitude towards and actual adoption of sustainable farming practices. However, digital sources of information such as TV and Radio do not play a significant role. In addition, pro-environmental attitude drives sustainable behaviour through the adoption of three out of the five sustainable farming practices investigated. Research and policy implications are also discussed.

Evaluating the effect of ursodeoxycholic acid on total bilirubin of neonates with glucose-6-phosphate dehydrogenase deficiency complicated by indirect hyperbilirubinaemia

AIM

This study aimed to investigate the effect of adding ursodeoxycholic acid (UDCA) to phototherapy in neonates with glucose-6-phosphate dehydrogenase (G6PD) deficiency and hyperbilirubinaemia. G6PD deficiency is a common cause of severe hyperbilirubinaemia in neonates.

METHODS

This study was a triple blind, clinical trial study of 40 neonates with G6PD deficiency and hyperbilirubinaemia who admitted for phototherapy in hospitals affiliated to the University of Medical Sciences. The treatment group (n = 20) received UDCA 10 mg/kg (2 cc/kg) daily divided into 2 doses every 12 h. The control group (n = 20) received the same volume of placebo syrup. The drug and placebo treatments were continued until the bilirubin level dropped below 171 μmol/L. Both the control and treatment group received continuous phototherapy. Independent sample t-test, survival analysis and logrank test were used to statistically analyse the results.

RESULTS

The mean total bilirubin level was 231.9 ± 18.8 μmol/L and 184.3 ± 18.6 μmol/L in the control and intervention group respectively, 24 h after drug administration and 209.7 ± 19.3 μmol/L and 157.4 ± 16.4 μmol/L, respectively, 48 h after intervention (P < 0.05). The median length of hospitalisation in the treatment group was approximately 1 day lower than the control group (logrank test P value: <0.001).

CONCLUSION

The study showed that the addition of UDCA to phototherapy accelerates the reduction of total bilirubin level in neonates with G6PD deficiency and can reduce the duration of hospitalisation.

Information Technology/Systems Adoption in the Public Sector

State government has been moving from manual and paper-based processes to digital services. However, digital divide, declining trust in technology, and low IT/IS adoption rates by public sector employees are important challenges for successful delivery of e-government services to citizens. Previous studies in the area of IT/IS adoption and e-government have mainly focused on citizens. This paper examines IT/IS adoption by employees rather than citizens and the focus is on non-market environment and state government agencies. A research model has been proposed based on the theory of planned behavior (TPB) and technology acceptance model (TAM) which has been extended to include digital divide related constructs and trust in technology. To test the proposed model, a survey was conducted among early adopters of Office 365 at Illinois Department of Transportation (IDOT) in Springfield and Chicago. The paper contributes to research on IT/IS adoption in public sector. The findings also provide insightful design and practical implications for successful IT/IS deployment in public sector.

A77 A REUSABLE POLYCARBONATE BOX TO DECREASE DROPLET CONTAMINATION DURING UPPER ENDOSCOPY: A SIMULATION-BASED STUDY FOR THE COVID-19 PANDEMIC

Background

Upper gastrointestinal (GI) endoscopic procedures are aerosol-generating, increasing the risk of healthcare workers (HCW) contracting Coronavirus disease 2019 (COVID-19).

Aims

To present a polycarbonate box (EndoBox) designed for use in upper GI endoscopy and evaluate its impact on the contamination of endoscopy staff during simulated procedures.

Methods

Simulated gastroscopies were performed using an upper body simulator placed in left lateral decubitus (LLD) and supine positions. The endoscopist and assistant wore personal protective equipment. Droplet exposure was measured using fluorescent abiotic surrogate particles. Two blinded observers independently viewed images from each scenario to qualitatively evaluate contamination levels. The primary outcome was the level of HCW contamination by droplets generated from a simulated cough with and without the EndoBox on the upper body simulator. The endoscopist’s ergonomic behaviour was also assessed using the Rapid Upper Limb Assessment (RULA) tool.

Results

Without the EndoBox, there was a higher level of contamination on the endoscopist when the upper body simulator is in the LLD position. A higher level of contamination was observed on the assistant when the simulator is in supine position. With the EndoBox, the contamination levels on the endoscopy staff were lower in both LLD and supine scenarios. The endoscopist’s ergonomics were rated 2 to 3 on the RULA tool when using the EndoBox.

Conclusions

The EndoBox reduces macroscopic droplet contamination during simulated gastroscopy. The endoscopist’s risk of musculoskeletal injury remained in the low risk categories as assessed by the RULA tool. Another advantage of the EndoBox design is the arch extending from the bottom that allows for removal of the box without withdrawing the endoscope. This enables rapid access to the patient’s airway if they experience respiratory distress. This study was limited by an inability to assess microscopic contamination and contamination at the level of the port or buttons when suction is applied. Within these limitations, the EndoBox may be a useful adjunct to traditional personal protective equipment.

Funding Agencies

SMHA AFP COVID-Related Innovation Funds

A71 RECOMMENDATION REVERSALS IN GASTROENTEROLOGY CLINICAL PRACTICE GUIDELINES

Background

Clinical practice guidelines are evidence-based resources designed to inform clinical decision making. Often, superior evidence will support the inclusion of novel procedures and practices to replace older recommendations. Recommendation reversals occur when (a) superior quality evidence emerges to suggest the harm or non-beneficence of prior recommendations, and (b) that recommendation is not supplanted by a newer one.

Aims

The primary objective of this study was to describe the content, frequency and rationale for recommendation reversals in CPGs published by gastroenterological societies.

Methods

For this meta-epidemiologic study, we considered two criteria to define a recommendation reversal: (a) the more recent CPG makes a recommendation that contradicts a previously accepted practice; and (b) the prior recommendation is not replaced by any novel intervention. We searched CPGs published by 20 major GI societies from 1991- 2019. Guidelines were included if had at least two iterations with the same title and used a valid evidence rating system (such as GRADE). Explicit recommendations which reported definite levels of evidence and strength of recommendation were extracted.

Results

We identified 1022 clinical guidelines from GI societies over 28 years. 292 CPGs were included for data synthesis. 5985 explicit statements were extracted. 12 reversals were confirmed and are summarized in the Table. Six reversals (50.0%) occurred due to studies reporting non-beneficence and 3 (25.0%) occrred due to studies reporting harm. Three recommendations (25.0%) were reversed due to new clinical trials; 3 (25.0%) due to systematic reviews or meta-analyses; and 2 to conform with CPGs of other societies (16.7%).

Conclusions

We describe recommendation reversals made in gastroenterology CPGs, and the reasons thereof. Investigation of recommendation reversals allows for the identification of low-value medical practices. This reinforces the need for GI CPG committees to (1) iteratively review guidelines to re-evaluate recommendations made on low-quality evidence and; (2) refrain from making recommendations when evidence for the same is weak.

Funding Agencies

None

Modeling Residential Energy Consumption

Smart meters that allow information to flow between users and utility service providers are expected to foster intelligent energy consumption. Previous studies focusing on demand-side management have been predominantly restricted to factors that utilities can manage and manipulate, but have ignored factors specific to residential characteristics. They also often presume that households consume similar amounts of energy and electricity. To fill these gaps in literature, the authors investigate two research questions: (RQ1) Does a data mining approach outperform traditional statistical approaches for modelling residential energy consumption? (RQ2) What factors influence household energy consumption? They identify household clusters to explore the underlying factors central to understanding electricity consumption behavior. Different clusters carry specific contextual nuances needed for fully understanding consumption behavior. The findings indicate electricity can be distributed according to the needs of six distinct clusters and that utilities can use analytics to identify load profiles for greater energy efficiency.

The Impact of Smart Meter Installation on Attitude Change Towards Energy Consumption Behavior Among Northern Ireland Households

The continuous development of energy management systems, coupled with a growing population, and increasing energy consumption, highlights the necessity to develop a deep understanding of household energy consumption behavior and interventions that facilitate behavioral change. Using a data mining segmentation technique, 2,505 Northern Ireland households were segmented into four distinctive profiles, based on their energy consumption patterns, socio-demographic, and dwelling characteristics. The change in attitude towards energy consumption behavior was analyzed to evaluate the impact of smart meter feedback as well. The key finding was 81% of trial participants perceived smart meters to be helpful in reducing their energy consumption. In addition, we found that the potential to reduce energy bills and environmental concerns were the strongest motivations for behavior change.

Association of vitamin D with the modulation of the disease severity in COVID-19

•

Insufficient levels of Vitamin D could be seen in COVID-19 patients.

•

Increase in the ACE could be seen in COVID-19 patients with higher quantities in the individuals who died from the COVID-19.

•

The Neutrophil to Lymphocyte ratio (NLR) is higher in COVID-19 than the control group.

•

Serum levels of vitamin D and ACE are associated with the progression and severity of the COVID-19.

In late 2019, SARS-CoV-2 started to spread throughout the world causing the COVID-19 that has taken a considerable number of lives. Results obtained from several investigations have explained the virus origin, pathogenicity, and transmission. Similar to SARS coronavirus, the pulmonary angiotensin converting enzyme (ACE) 2 was introduced as the virus receptor for entering the cell. An increased body of epidemiological and clinical evidences has shown modulating effects of vitamin D in lung injuries through several mechanisms. Several clinical symptoms as well as molecular factors have shown to be related to the disease transmission and severity. In this study, vitamin D, ACE concentrations, and neutrophil to lymphocyte ratio (NLR) were measured in patients with confirmed COVID-19 in comparison with control group. Results demonstrated significant alterations in vitamin D and ACE levels as well as NLR in the patients’ group. Contribution of those factors with the prognosis and severity of the disease has been shown.

A243 FACTORS ASSOCIATED WITH POOR QUALITY OF LIFE IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE IN CLINICAL REMISSION: A CROSS-SECTIONAL STUDY

Background

Inflammatory bowel disease (IBD) is associated with a substantial burden on quality of life (QoL). Functional gastrointestinal disorders such as irritable bowel syndrome (IBS) as well as depression and anxiety are more common in patients with IBD as compared with the general population. Although poorer QoL is correlated with IBS, depression and anxiety in individuals with IBD at times of IBD diagnosis and disease activity, it is unclear what, if any, impact these may have on overall quality of life at times of disease remission.

Aims

We aimed to identify factors associated with poor QoL among Canadian patients with IBD in clinical remission.

Methods

We conducted a prospective, cross-sectional study to determine whether fatigue, depression, anxiety and IBS were associated with lower QoL in patients with IBD in clinical remission. We enrolled patients at a single academic tertiary care center with inactive IBD. All eligible patients completed a series of questionnaires that included questions on demographics, disease activity, anxiety, depression, and the presence of irritable bowel syndrome (IBS) symptoms. Stool samples for fecal calprotectin (FC) were also collected to assess for subclinical inflammation. The primary outcome measure was QoL assessed by the short inflammatory bowel disease questionnaire (SIBDQ), with planned subgroup comparisons for fatigue, anxiety, depression and IBS symptoms.

Results

Ninety-three patients were eligible for inclusion in this study. The median SIBDQ scores were lower in patients with anxiety (P&lt;0.001), depression (P=0.004), IBS symptoms (P&lt;0.001), and fatigue (P=0.018).

Conclusions

In this cross-sectional study, we found that anxiety, depression, fatigue, and IBS-like symptoms were all independently associated with lower QoL among patients with inactive IBD. Importantly, subclinical inflammation as defined by a positive fecal calprotectin in the absence of clinical symptoms did not have an adverse effect on QoL. The findings of this study suggest that patients with IBD would likely benefit from screening for depression, anxiety, fatigue and IBS. Further research is warranted to determine if targeted treatment of these conditions, specifically in patients with quiescent IBD would lead to improved outcomes.

Funding Agencies

None

A143 IMPACT OF A SIMULATION-BASED AUGMENTED REALITY CURRICULUM ON POLYPECTOMY SKILLS AMONG NOVICE ENDOSCOPISTS: A RANDOMIZED CONTROLLED TRIAL

Background

Polypectomy is an essential endoscopic skill. Training in polypectomy has been identified as a major deficiency for endoscopists worldwide as polypectomy occurs ad hoc during a colonoscopy when a polyp is detected, and a lack of standardized curricula. Augmented reality (AR), which superimposes computer-generated images on a user’s view of the world, can address these gaps by standardizing encounters with polyps while completing simulated procedures and enabling polypectomy-specific teaching.

Aims

Evaluate the impact of a simulation-based augmented reality curriculum on polypectomy performance among novice endoscopists.

Methods

This study includes two cohorts of participants from 2019 to 2020. In 2019, participants were randomized into either: (1) a control curriculum, involving 6 hours of simulation-based training (SBT) supplemented by expert feedback, interlaced with 4 hours of small group teaching on the theory of colonoscopy; or (2) the augmented reality curriculum (ARC), in involving the same curriculum with integrated AR, wherein participants engaged with an AR-enhanced video demonstrating relevant therapeutic and pathologic details during polypectomy. The SBT for all participants involved a progressive curriculum starting on a bench-top model and then moving to the EndoVR® virtual reality simulator. The primary outcome was polypectomy-specific performance using the Direct Observation of Polypectomy Skills (DOPyS) tool during a simulated polypectomy after training, with a maximum score of 100.

Results

Demographic characteristics are summarized in Table. In 2019, 21 novice endoscopists were enrolled. Immediately after training, the mean DOPyS score among ARC group participants was 76.2 (SD=17.9) compared to 71.8 (SD=13.2) among control group participants (Figure). In this interim analysis, there was no significant difference between groups. Data analysis will be completed after 2020 participants complete the study.

Conclusions

Interim results show a trend towards improved polypectomy performance with no significant difference. The results of this study have the potential to impact polypectomy education among novices. Simulation-based AR interventions may allow learners to progress towards achieving competency in polypectomy in a risk-free environment prior to first patient contact.

Funding Agencies

None

Adoption of Smart TV in UK and the Moderating Role of Viewer Classification

The UK TV market is a dynamic and rapidly evolving industry. This article investigates the factors affecting adoption intention of Smart TV in UK, and whether the customer's perception varies according to their viewing behavior and motivation. The proposed research model is empirically verified through an online survey of early adopters. Previous research has highlighted the gap in Smart TV research which is the consumer behavior perspective. The current study addresses this gap by integrating different theoretical perspectives from IT adoption and mass communication literature, providing a better explanation of Smart TV adoption and viewing behavior by end users. The findings also provide practical insight for marketers and policymakers of Smart TV devices and content providers in order to develop successful segmentation strategy.

Therapeutic touch for nausea in breast cancer patients receiving chemotherapy: Composing a treatment

BACKGROUND AND OBJECTIVE

Therapeutic touch (TT) is independent nursing intervention which is effective on nausea induced by chemotherapy but technique, steps and variables affected by this therapy are not yet well known. The aim of this study was to elicit descriptions of how TT is used with cancer patients, providing a basis for the systematic use and evaluation of TT with patients.

MATERIALS AND METHOD

In this research, 108 patients were examined with intentional sampling and random allocation in 3 groups (control, placebo and intervention) in 2013 (each group 36). Intervention received therapeutic touch (touching of first energy layer) and demographic form, visual analog scale (VAS) for intensity of nausea, check list for duration and times of nausea in the morning, noon, afternoon and night at acute phase were used. Data were analyzed by Kruskal Wallis, χ(2) and analysis of variance (ANOVA).

RESULTS

Duration, frequency and intensity of nausea were significantly lower in the test group (P < 0.001, P < 0.001 and P < 0.001). The mean duration of intervention (whole process) was 21.38 min [SD 6.04]. In 69.4% of women there was a need for re-intervention after reassessment phase.

CONCLUSION

Results of this randomized control trial showed that TT is effective on duration, times and intensity of nausea; therefore, TT can be used as an alternative method for patients who are willing to use this technique.

Secular trend of menopausal age and related factors among Tehrani women born from 1930 to 1960; Tehran Lipid and Glucose Study

BACKGROUND

Menopause is an important milestone of a woman's reproductive life. There is limited data on the secular trend of menopausal age. The purpose of this study is to identify the secular trend of menopausal age and its related factors among Tehrani women born during 1930 - 1960.

METHODS

A total number of 2266 women, born between 1930 and 1960, were recruited among TLGS participants. The World Health Organization classification was used to define menopause status. Birth cohorts were created using 10-year periods, and statistical comparisons were performed with analysis of covariance (ANCOVA).

RESULTS

The means for menopausal age of women born in the 1930s, 1940s and 1950s were 48.5, 49.5 and 49.9 years, respectively. After adjustment for possible confounding factors in the linear regression model, the increasing trend of menopausal age was constant (P = 0.029).

CONCLUSION

There is an increasing trend in menopausal age in female residents of Tehran. These findings have implications for endogenous lifetime exposure of women to gonadal steroids.

Factors influencing menarcheal age: results from the cohort of tehran lipid and glucose study

BACKGROUND

Menarche is considered as a milestone in the women's reproductive life. Most existing studies on factors influencing menarcheal age had cross-sectional designs and their finding were controversial.

OBJECTIVES

We aimed to determine some factors affecting the age at menarche in a cohort study with an average of ten-year follow-up; the study was conducted within the framework of Tehran Lipid and Glucose Study (TLGS).

MATERIALS AND METHODS

For the purpose of the present study, we recruited all the females aged 12 to 18 years participated in TLGS whose menarche had not begun at the initiation of the study, but occurred during their follow-up. The effect of premenarcheal status of various factors including socioeconomic and anthropometric parameters, physical activity, energy expenditure, and exposure to tobacco smoke on menarcheal age was explored.

RESULTS

The mean of age at menarche was 13.06 ± 1.24 years. There were significant statistical associations between age of the participants' mothers at menarche (r = 0.66, P < 0.001), maternal education (r = -0.04, P = 0.002), and body mass index (BMI) before menarcheal (r = 0.25, P = 0.027) with age at menarche. There was no significant correlation between age at menarche, with either of maternal employment, premenarcheal physical activity, energy expenditure, and passive smoking.

CONCLUSIONS

Among various factor influencing menarcheal age, premenarcheal BMI is modifiable, and considering its significance, could prevent early or late menarches.

Relationship between air pollution and pre-eclampsia in pregnant women: a case-control study

Pre-eclampsia is the main cause of maternal and fetal death and disability worldwide. Its incidence in the Islamic Republic of Iran is 5%-12%. Air pollution has been reported to be one of the causative factors, and this case-control study determined its effect on pre-eclampsia in 195 pregnant women (65 with pre-eclampsia and 130 without) admitted to hospitals in Tehran. Women were divided into high and low exposure groups according to the mean density of exposure to pollutants during pregnancy. There was no statistically significant relationship between exposure to air pollutants including CO, particulate matter, SO2, NO2 and O3 and pre-eclampsia. The combined effect was also not significant. Air pollution is one of the problems of modern society and its avoidance is almost impossible for pregnant women. This study should reduce concern about pregnant women living in polluted cities.

Rise in cesarean section rate over a 30-year period in a public hospital in Tehran, Iran

BACKGROUND

Numerous studies show a growing trend in cesarean section rates throughout the world, including Iran. However, existing evidence in our country is scant and previous reports are restricted to short time periods. The aim of the current study is to measure the trend in cesarean sections (CS) rates over the past 30 years in a referral hospital in Tehran.

METHODS

We routinely collected data on the demographic characteristics of all women who gave birth in the hospital during the study period. The mode of delivery and the personnel in charge of delivery has likewise been recorded for each birth during the study period. The data were extracted from medical records and entered into a structured checklist.

RESULTS

The rate of CS out of all deliveries increased from 14.3% in 1979 to 22.7% in 1989, 52.5% in 1999, and 85.3% in 2009 (P < 0.001). The most common reason for CS was a repeated section. The percentage of vaginal deliveries performed by midwives has not changed significantly and the number of both midwives and obstetricians per 1000 births has increased, from 2.8 to 15.4 midwives per 1000 births and from 5.5 to 23.0 obstetricians per 1000 births.

CONCLUSION

Immediate strategies should be adopted to prevent the rising trend and increasing number of unnecessary CS in Iran.

Do Foreign Direct Investment (FDI) and Trade Openness Explain the Disparity in ICT Diffusion between Asia-Pacific and the Islamic Middle Eastern Countries?

This study investigates the impact of FDI and trade openness on ICT diffusion in the Asia-Pacific and Middle East regions from 1996-2005. The results indicate that while dissimilarities exist between the economies included in this study in terms of their level of socio-economic and political development, education and the growth of GDP have had a positive impact on ICT diffusion in both regions. However, while FDI has generally had a positive and significant impact on ICT diffusion in Asia-Pacific economies, its impact on Middle Eastern economies has been detrimental. The results of this study also show that trade-openness has had, in general, a positive and significant impact on ICT diffusion.

The Core Critical Success Factors in Implementation of Enterprise Resource Planning Systems

The Implementation of Enterprise Resource Planning (ERP) systems require huge investments while ineffective implementations of such projects are commonly observed. A considerable number of these projects have been reported to fail or take longer than it was initially planned, while previous studies show that the aim of rapid implementation of such projects has not been successful and the failure of the fundamental goals in these projects have imposed huge amounts of costs on investors. Some of the major consequences are the reduction in demand for such products and the introduction of further skepticism to the managers and investors of ERP systems. In this regard, it is important to understand the factors determining success or failure of ERP implementation. The aim of this paper is to study the critical success factors (CSFs) in implementing ERP systems and to develop a conceptual model which can serve as a basis for ERP project managers. These critical success factors that are called “core critical success factors” are extracted from 62 published papers using the content analysis and the entropy method. The proposed conceptual model has been verified in the context of five multinational companies.

The Post-Adoption Phase of Broadband in Small Businesses

In spite of the increasing significance of broadband, many small and medium enterprises (SMEs) are unaware of or unappreciative of its benefits. This is potentially a problem for governments, Internet Service Providers and other supply side institutions. The current study empirically verifies applicability of an extended IS continuance model controlling for organizational variables based on the Technology-Organization-Environment framework to examine factors influencing broadband post-adoption behavior of SMEs in Singapore. Strong support for the model has been manifested by the results, providing insight into influential factors. Results of the study suggest that perceived usefulness is a strong predictor of users’ continuance intention, followed by satisfaction with broadband usage as a significant but weaker predictor. SMEs in a more competitive business environment and whose key executive possesses greater IT knowledge are more likely to use broadband.

Is ICT the Key to Development?

Using panel data for 52 developed and developing countries over the period 1998-2006, this article examines the links between information and communication technology diffusion and human development. We conducted a panel regression analysis of the investments per capita in healthcare, education and information and communication technology against human development index scores. Using a quantile regression approach, our findings suggest that changes in healthcare, education and information and communication technology provision have a stronger impact on human development index scores for less developed than for highly developed countries. Furthermore, at lower levels of development education fosters development directly and also indirectly through their enhanced effects on ICT. At higher levels of development education has only an indirect effect on development through the return to ICT.