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This study aimed to explore healthcare providers' (HCP) stigmatization from patients during the COVID-19 outbreak in Jordan.A cross-sectional design was used. Data collection was conducted between May and July 2021. The research questionnaire included demographic information about participants and multiple statements that reflect stigma of participants toward HCPs. Regression analysis was conducted to assess the association between stigma and explanatory variables.A total of 777 surveys were included in the study. Many people show high stigma toward HCPs during COVID-19 pandemic. Various factors including hearing news all time (p.001), having children (p.024), and smoking (p.001) were significant in prediction stigma toward HCPs.This one of few studies conducted in Jordan regarding the stigma toward HCP from other people with chronic diseases. Our study found that many people showed some stigma toward HCP during COVID-19. Stigmatization of HCP related to a pandemic is a lesson most people have not learned. It is not enough to cheer HCPs. A clear, sensible public education campaign about the public's risks by interacting with HCP is necessary.

Background. The aim of the study was to examine changes in the frequency of respiratory diseases during the COVID-19 pandemic and to correlate the changes with nonpharmacological interventions for overcoming the pandemic. In addition, the study explored the predictors of adherence to nonpharmacological interventions among the Jordanian public. Method. The study is survey-based and self-reported, using convenient sampling. The study was conducted during October–November of 2021. Results. The study included 1714 participants. About one-quarter of participants reported decreases in the incidence of cold (21.9%), influenza (24.7%), respiratory infections other than cold and influenza (23.3%), tonsillitis (23.0%), and oral ulcers (23.5%). On the other hand, the majority reported no change in the incidence of the above infections (62.0–64.4%). Adherence of the sample to nonpharmacological interventions of COVID-19 was moderate. The percentages of people who always wear a mask, follow social distancing, and use sanitizing procedures were 47.1%, 37.8%, and 68.8% respectively. ANOVA test showed a significant correlation between the incidence of respiratory/oral infections and adherence to nonpharmacological interventions. The multiple regression test showed that people who followed COVID-19 news, have children, have a job, and being married were more adhered to nonpharmacological measures compared to others. Conclusion. Implementation of nonpharmacological interventions used to overcome the COVID-19 pandemic can be applied to reduce other respiratory infections during their peak seasons.

Purpose: This study aimed at examining nurses’ knowledge, attitudes, and practices related to antibiotics use and resistance. A second objective was to identify Jordanian nurses’ sources of information about antibiotics. Method: A cross-sectional design was used for this study. Nurses (n=594) completed an online survey using Google Forms. Google Forms web link was distributed on Facebook, LinkedIn, Twitter, and other social media applications. The study included Jordanian nurses who worked in hospitals and healthcare institutions. the European Center for Diseases Control and Prevention survey was used that took about 15 minutes to complete. Results: According to the study, 48.2% of nurses prescribed antibiotics to patients daily or multiple times per day in the previous week; 13.3% of nurses offered support for daily or more frequent antibacterial drug use or infection control; and 42.3% of nurses mentioned they did not give antibiotics advice because they did not have a leaflet about their use and because the patients did not receive one. Conclusion: The study found that the most reported source for antibiotics information was Facebook and Instagram. Nurses need further education on proper use of antibiotics. Antimicrobial stewardship can benefit from the study findings, which can help develop interventions to improve antibiotics proper use.

Aim: This study aims to examine the nurse knowledge, motivation, and behavior about antibiotics and antibiotic resistance. A secondary objective was to study the preferred information sources used by Jordanian nurses, as well as their knowledge of the information available to promote rational prescription practices in the Jordanian health system. Method: The study was cross-sectional in design and nurses (n=1,093) completed an online survey using Google Forms. Participation in the study was completely optional, and participants were free to drop out at any point. During the months of February-May 2022, nurses were asked to participate in a survey Results: The study found 48.2% of nurses given prescribed antibiotics to the patients daily or multiple times a day in the preceding week; 13.3% of nurses provided support on daily or more frequent antibacterial drugs use or infection management. The reason for not giving advice regarding antibiotics were no leaflet regarding the use of the antibiotics (42.3%) and the patients do not get attention for the information (30.4%). Conclusion: In conclusion, the findings of this study show that public health actions are needed (e.g., educational or communication campaigns). Nurses must be educated on the proper use of antibiotics and the emergence of antibiotic resistance. Antibiotic stewardship can benefit from the findings, which can be used to develop interventions aimed at improving antibiotic usage.

Background Emerging health professionals in undergraduate programs should be equipped to provide care to people with substance use disorder (SUD). The students’ personal attributes may impact their attitude toward those with SUD. This study aims to evaluate the impact of personal attributes of Jordanian undergraduate health students on their attitudes toward SUD and examine the relationship between the personal attributes and their devaluation and discriminatory (stigmatory) behaviour toward those with SUD. Method A cross-sectional descriptive design was used to examine the attitudes and stigmatory behaviours. The data were collected between May to October 2017 with a structured questionnaire that consisted of three parts: 1) a data sheet to collect the socio-demographic characteristics of the participants, 2) the Acute Mental Health Scale (ATAMHS), and 3) the Devaluation-Discrimination Scale (DDS). Findings Younger and females demonstrated a positive attitude toward those with SUD compared to older or male students. Age, gender, and previous experience with SUD are significant factors that affect their attitude. Conclusion Identifying the attitude to people with SUD and personal attributes of emerging health professionals in Jordan will help identify the need to educate them prior to their entry into practice.

Background: Spirituality has been recognised as an essential aspect of patient care. Aim: To assess the greatest facilitators that would help to provide spirituality for paediatric end of life. Methods: Two hundred and fifty oncology nurses were surveyed using a spirituality and spiritual care rating questionnaire. Findings: The greatest facilitators perceived by nurses were: believe in spirituality as a unifying force that enables one to be at peace with oneself and the world; listening and allowing patients time to discuss and explore their fears; and using art, creativity and self-expression; respect for privacy, dignity and religious and cultural beliefs of a patient. Conclusions: Many nursing-related facilitators to spirituality care were found. They need to be addressed and supported through education and training.

Awareness of poor sleep quality and sleep disturbances, as some of the factors that affect negatively quality of life for patients with the different classes of heart failure (HF) would enable health care providers to offer more comprehensive care. The purposes of this study were to describe sleep quality and predictors of disturbances in sleep in heart failure patients in Jordan. An explanatory cross- sectional design was employed to examine sleep quality, dimensions of sleep characteristics, types of disturbances in sleep within the different classes of HF in Jordan. Data were collected from 2 cardiac clinics and 2 medical clinics at 3 hospitals in Jordan. The most common types of disturbances in sleep in all classes of HF were waking up for urination, waking in the middle of the night or early morning, waking up due to cough and snoring, and difficulty to fall asleep within the 30 minutes. However, waking up due to feeling cold or hot were rarely reported in all classes of patients with HF. Regression analysis revealed that significant correlations were found between sleep quality and gender, disease duration, number of medications currently taken and ejection fraction (P .05). Our findings indicated that sleep quality and disturbances in sleep were worsening with the increase of the New York heart association functional classification sheet class. Moreover, sleep quality had a significant association with gender, disease duration, ejection fraction, and the number of medications currently taken.

AIMS The aims of this study were to identify midwives' and obstetricians' attitudes towards midwives practised roles in hospitals and to identify the differences in their attitudes towards midwives practiced roles. MATERIALS AND METHODS A descriptive, cross-sectional, study design was used. A convenience sample of 303 midwives and 143 obstetricians were recruited. Participants were from 12 Ministry of Health (MOH) and Royal Medical Services (RMS) hospitals distributed across seven governorates. Two reliable and valid self-administered questionnaires were used to collect data including socio-demographic data-related characteristics of participants and obstetricians' and midwives' attitudes towards midwives' practiced role in hospitals. RESULTS There were significant differences between obstetricians in the three subscales of attitudes: midwives women relationship attitude subscale, midwives trust and mutual respect subscale and work environment attitudes subscale. A significant difference by the institution was reported: obstetricians and midwives who worked in MOH reported more positive attitudes than those who worked in RMS. CONCLUSION The results show that obstetricians recognise that midwives are qualified and competent professionals but still lack the competencies/skills to make them independent practitioners. The findings also confirm the need to improve midwives' practices by moving from being able to perform a specific task to possess all three attributes of "competencies," where they can intervene, manage and make decisions with confidence in each situation. IMPLICATION FOR PRACTICE Based on the current study findings, parallel cooperation between educational/academic policymakers from both midwives and obstetricians may re-evaluate and upgrade the midwifery curriculum to meet the ICM competencies and health sector needs as a step to graduate competent midwives where their responsibility is recognised and organised.

BACKGROUND: This research aimed to survey a sample of nursing students and Doctor of Pharmacy (PharmD) students in Jordan about their knowledge of pediatric palliative care (PPC) in the context of treating terminally ill children. METHOD: A descriptive, cross-sectional, correlational design was used to fulfill the goal of this research. A convenience sample of nursing and PharmD students currently studying in Jordan University of Science and Technology in Jordan was recruited to complete a survey that contained 20 statements about issues on and around the subject of PPC. RESULTS: The results showed that there was a significant difference in PPC between nurses and PharmD students. The mother’s education (t = 2.158, P = 0.032) and being a nursing or PharmD student (t = 1.969, P = 0.050) were associated with knowledge about PPC. Other listed factors such as gender, working ward, and age were not associated with knowledge of PPC. CONCLUSION: This was the first study in Jordan to survey a sample of nursing students and PharmD students in Jordan about their knowledge of PPC. The current study found that knowledge of nursing and PharmD students regarding PPC was satisfactory, depending on the scale used.

Multidisciplinary topics in education pose a major challenge for traditional learning and teaching methods. Such topics can deter students from selecting particular courses or hinder their study progress. This study focused on the subject of medicinal chemistry, which is a discipline combining medicine and chemistry. This combination of applied and basic science creates a complex field of education that is challenging to both teach and learn. Chemical and pharmacological principles are typically presented in 2D molecular structures and, recently, 3D molecular models have been utilized to improve the visualization of chemical compounds and their chemical interactions. Contemporary studies have presented Virtual Reality (VR) as an alternative method for improving the learning and teaching of multidisciplinary specialties such as this. However, current educational efforts employing VR offer limited interactivity and a traditional teaching method previously presented in 2D. This reduces students’ interest and concentration in the taught subjects. This paper presents the development rationale of a novel VR educational application based on the evaluation of the user requirements by 405 pharmacy undergraduate students. The results informed the development and preliminary evaluation of a proposed VR serious game application, which was deployed in a real-life class environment and evaluated in contrast to traditional teaching methods by 15 students. The derived results confirmed the advantages of VR technology as a learning and teaching tool, in addition to the end-users’ willingness to adopt VR systems as a learning aid.

The current study aimed to estimate the prevalence of depression, anxiety, and suicidality and their correlated factors among high school students in Jordan. A descriptive cross-sectional correlational research design was used. Data were collected using self-reported questionnaires completed by students attending high schools in Jordan. Data show that anxiety and depression are prevalent among adolescents and are associated with higher risk of suicide and disease prevalence. Twenty-seven percent of the variance in suicidality is explained by anxiety and depression. This finding indicates that the most significant predictor of suicidality is anxiety and depression among high school students. Results show that mental health issues are a genuine general health issue among high school students. Health care professionals should routinely screen for mental health problems among young people. Mental health and well-being advancement programs should be coordinated and directed by all parties involved in youth mental health. [ Journal of Psychosocial Nursing and Mental Health Services, 59 (8), 43–51.]

Background The use of illicit substances is a critical international issue that must be addressed by healthcare systems worldwide. Today, the problem of illicit substance use is increasingly becoming a burden on healthcare systems in both developed and developing countries. The aims of this study were: (1) to describe the attitudes of health major undergraduate students (the study participants) toward illicit substance users; (2) to describe the discriminatory behaviors among the study participants toward illicit substance users; and (3) to examine the relationship between the attitudes and the actual discriminatory behaviors of the study participants. Method A cross-sectional descriptive design was used to investigate the attitudes and behaviors of health professional undergraduate students enrolled at university in Jordan. Results Students who were younger and identified as female were generally more positive toward illicit substance users versus those students who were older and identified as male. Conclusion The findings of this study supported the literature that students who were younger and identified as female were generally more positive toward illicit substance users versus those students who were older and identified as male. It is therefore important to determine whether the type of courses in health majors available for undergraduate students affects their attitudes toward illicit substance users., Attitude, Discriminatory behaviors, Health professional undergraduate students, Jordan, Healthcare.

Significance Targeting CDK4/6 shows great promise in the treatment of many solid cancers, including melanoma. This study has uncovered a mechanism of action of CDK4/6 inhibitors in regulating the MDM4 oncogene and the tumor suppressor, p53. In melanoma, palbociclib activates p53 via modulating PRMT5-dependent alternate MDM4 pre-mRNA splicing, which results in a robust decrease in MDM4 protein expression. Loss of palbociclib regulation of the PRMT5–MDM4 axis leads to drug resistance. Dual inhibition of CDK4/6 and PRMT5 potently suppresses melanoma tumor growth and is well tolerated in vivo. Our findings not only have immediate implications for the advancement of CDK4/6 inhibition for treating melanoma, but also more generally offer insights into CDK4/6 mechanism of action., Cyclin-dependent kinase 4/6 (CDK4/6) inhibitors are an established treatment in estrogen receptor-positive breast cancer and are currently in clinical development in melanoma, a tumor that exhibits high rates of CDK4 activation. We analyzed melanoma cells with acquired resistance to the CDK4/6 inhibitor palbociclib and demonstrate that the activity of PRMT5, a protein arginine methyltransferase and indirect target of CDK4, is essential for CDK4/6 inhibitor sensitivity. By indirectly suppressing PRMT5 activity, palbociclib alters the pre-mRNA splicing of MDM4, a negative regulator of p53, leading to decreased MDM4 protein expression and subsequent p53 activation. In turn, p53 induces p21, leading to inhibition of CDK2, the main kinase substituting for CDK4/6 and a key driver of resistance to palbociclib. Loss of the ability of palbociclib to regulate the PRMT5–MDM4 axis leads to resistance. Importantly, combining palbociclib with the PRMT5 inhibitor GSK3326595 enhances the efficacy of palbociclib in treating naive and resistant models and also delays the emergence of resistance. Our studies have uncovered a mechanism of action of CDK4/6 inhibitors in regulating the MDM4 oncogene and the tumor suppressor, p53. Furthermore, we have established that palbociclib inhibition of the PRMT5–MDM4 axis is essential for robust melanoma cell sensitivity and provide preclinical evidence that coinhibition of CDK4/6 and PRMT5 is an effective and well-tolerated therapeutic strategy. Overall, our data provide a strong rationale for further investigation of novel combinations of CDK4/6 and PRMT5 inhibitors, not only in melanoma but other tumor types, including breast, pancreatic, and esophageal carcinoma.

Tyrosine Kinase 2 (TYK2) inhibition is of potential therapeutic value for treating autoimmune diseases. An elaborate ligand-based computational workflow was employed to explore structural requirements for TYK2 inhibition. Genetic function algorithm (GFA) was coupled to k-nearest neighbor (kNN) and multiple linear regression (MLR) analyses to search for predictive QSAR models based on optimal pharmacophore(s)/physicochemical descriptors combinations. QSAR-selected pharmacophores were validated by receiver operating characteristic (ROC) curve analysis and by comparison with crystallographic structures of known inhibitors complexed within the TYK2 binding pocket. Optimal QSAR models and their associated pharmacophore hypotheses were used to identify new TYK2 inhibitory leads retrieved from the National Cancer Institute (NCI) structural database. The most potent hit exhibited experimental anti-TYK2 IC50 of 7.1 µM.

Objective This study aimed to examine the effectiveness of a childbirth preparation course on birth outcomes among nulliparous Jordanian women. Design A randomized control trial pre-test/post-test design was used to assess the effects of a childbirth preparation course conducted in a military hospital in Amman, Jordan from 1 July to 15 September 2016. A total of 133 low-risk nulliparous women were recruited and randomly assigned to either (1) a control group who received standard care in antenatal clinics or (2) an intervention group who received standard care in antenatal clinics as well as a childbirth preparation course specifically designed for the purpose of this study. Data were collected at two different time points: at recruitment and within 24 to 48 h after giving birth. The chi-square test and independent sample t-test were used to compare birth outcomes. Participants Low-risk nulliparous women in their third trimester of pregnancy attending antenatal clinics at King Hussein Medical Centre in Amman, the capital of Jordan. Measurements and findings The childbirth preparation course had a positive effect on three birth outcomes. Specifically, more women in the intervention group than in the control group had spontaneous onset of labour (89.0% vs 70.3%, p = .02), the average of cervical dilation was greater in the intervention group than in the control group [(mean = 3.8, SD = 1.55) vs (mean = 3.2, SD = 1.61); t = 2.24, p = .03] and there was earlier initiation of breastfeeding in the intervention group than in the control group [(mean = 6.2, SD = 0.4.43) vs (mean = 17.8, SD = 18.08); t = 4.90, p ≤ 01]. Key conclusions The findings suggest that the childbirth preparation course increased the likelihood of pregnant women having spontaneous onset of labour and arriving at the maternity ward in active labour. Moreover, it helped them to initiate breastfeeding earlier after birth. No effect was found for other birth outcomes or neonatal outcomes. Further studies with a larger sample are needed to obtain more definitive conclusions. Implication for practice It is recommended that policymakers and administrators facilitate the embedding of this childbirth preparation course into antenatal care to improve maternal and neonatal health.

The purpose of the current study was to explore knowledge of, attitudes about, and perception of stigma among nursing students in relation to mental illness, and to identify the predictors of stigma toward patients with mental illness based on nursing students' characteristics, knowledge, and attitude. A cross-sectional survey was conducted on 169 participants from a university in Jordan. The regression model predicted a relatively moderate proportion of variance in stigma perception. Significant predictors in the model were family income, father's educational level, and experience with mental health patients. Findings of the current study showed that undergraduate nursing students who had experience with patients with mental illness hold relatively positive perceptions toward mental health patients. Enhancing the content of nursing curriculum regarding issues related to patients with mental illness could help students develop better assessment skills, have more positive attitudes, and gain more accurate knowledge about mental illness. [ Journal of Psychosocial Nursing and Mental Health Services, 57 (1), 43–51.]

Background: Poor maternal sensitivity leads to insecure infant attachment, and has been associated with negative cognitive consequences later in life. Maternal sensitivity is an indicator of the interactions between mothers and infants characterized by mutual and concurrent interchanges. The aim of the study is to review and synthesize all published studies that examine the potential effect of breastfeeding on maternal sensitivity during the first year of life. Materials and Methods: Searches were conducted using the following databases: Medline (via PubMed), CINAHL, and SCOPUS. Inclusion criteria were as follows: published in English, and no limitation on publication date. Articles were excluded if they did not focus on the main concepts of this review, maternal sensitivity, if they focused on the physiological aspects of breastfeeding or if they included children breastfed after one year of age. Results: Nineteen out of 60 articles met the inclusion criteria. All of the studies that were identified for this review were quantitative. Four categories emerged from these studies: Potential effects of breastfeeding on maternal sensitivity; Potential effects of breastfeeding-related environmenton maternal sensitivity; Potential effects of infant’s health on maternal sensitivity, and No potential effect of breastfeeding on maternal sensitivity. Conclusion: There is strong evidence that a relationship exists between breastfeeding and maternal sensitivity. However, that relationship is not well-defined .Identification of breastfeeding as a factor to enhance maternal sensitivity for newly and multi-children mothers will or may assist health care providers and social workers to help mothers improve their interactions with their infants to an optimal level.

Aims of the study This study aims to determine females' views, experiences and attitudes regarding the caesarean section (CS) and to explore the factors that increase the prevalence of CS in Jordan. Design This is a cross-sectional study using a questionnaire that was distributed electronically through social media websites. Study participants included 1005 females with a history of at least one CS. Awareness, experiences about CS, complications and reasons for performing CS were investigated. Settings The participants were recruited from all Jordan cities by social media and emails. Findings Most of the respondents stated that the source of their knowledge about CS was from the internet (36.2%) followed by family and friends (31.6%). The majority of respondents were satisfied with their CS experience (72.8%). More than half of the participants (56.9%) reported that CS carries no risk for infants. About 53% of respondents stated that the most common reason leading women to choose to give birth via CS is the fear of labour pain. However, the majority of the respondents disagree with performing CS under maternal request (59.2%). Conclusions and implications This study indicated that Jordanian females do not have reliable sources of information about CS. This leads to lower awareness of CS and its complications, and, as expected, CS is more likely to be performed by privately insured women.

PURPOSE Issues related to life and death are largely influenced by the culture and religious beliefs of a society. This research aimed to survey a sample of oncology nurses in Saudi Arabia about their attitude towards the do not resuscitate order (DNR). METHOD A cross-sectional design was employed. A survey was sent to 190 nurses in the Comprehensive Cancer Center (CCC) in King Fahad Medical City (KFMC). A total of 157 nurses with a diploma or higher degree agreed to participate in the study. RESULTS Many nurses showed a neutral attitude regarding DNR to cancer patients and/or their families 2.4 ± 0.4. Moreover, the results of the multiple logistic regression tests revealed that all the listed factors are not associated with the attitude towards DNR orders (P > .05). CONCLUSION It is generally believed that nurses the faith and background of nurses from Muslim countries has a profound influence on their attitude towards DNR. However, this was not the picture that was revealed by the results of this study. In this study, all the nurses made it clear that they wanted to know about the autonomy of patients in respect of DNR orders. IMPLICATION TO CLINICAL PRACTICE It is necessary to develop programmes that address the DNR order and respect patient autonomy and rights. Moreover, hospital policies that address the issues of DNR order are required for all end-of-life care.

Background Investigating temperament has been a multi-subject exercise that attempts to determine the contribution of temperament to additional measurable phenomena like behavior. The existing research not only evaluates temperament as a variable with the ability to influence additional characteristics but has included interventions that can result in adapted outcomes. Develop an Arabic translation of the Infant Characteristics Questionnaire (ICQ). Purpose Examine the psychometric properties of the translation and establish modified criteria for evaluating the questionnaire. Methods Cross sectional design was used. Translation of the ICQ was achieved through translation/back translation. The population that used the ICQ translation on convenience sample of 40 Arabic-speaking women with children between the ages of 3–12‐months old; this same group also completed a demographic survey. Results The internal consistency of the translated instrument was almost equivalent to or higher than the reported from the United States (US) review. The alpha coefficients calculated from subscales varied between .47 and .87. Conclusion This research study described the translation of the ICQ into the Arabic language for use in the research and clinical setting. The ICQ is a useful tool for evaluating infant difficulty by describing and summarizing parents’ ratings., Highlights • In nursing for infants, the parent-child, is very significant and is often understood as bilateral, correlative and interdependent. • Infant temperament is described as regularities in responding to different situations, and reflect a infant's behavioral characteristics. • The information gathered from infant-temperament questionnaires can help health care professionals inform parents of interventions for improving infant temperament.

Background In the telepharmacy model, the pharmacist can play a pivotal role in delivering pharmaceutical services for patients. However, evidence of pharmacists’ impact on improving patient outcomes through disease outbreak through telepharmacy is sparse. Objectives This study aims to examine pharmacists' attitudes towards clinical benefits and identify challenges regarding the use of telepharmacy during the COVID‐19 pandemic in Jordan. Method A cross‐sectional survey design was used to recruit eligible participants from both hospital and community pharmacies. Results A total of 364 pharmacists agreed to participate in the study. The majority of the participants (70.6%) expressed favourable attitudes towards telepharmacy to accurately capture and report signs and symptoms of COVID‐19. Almost 91% agreed that patients can receive immediate medical feedback while using telepharmacy services. Pharmacists (87%) emphasised their role in the monitoring of physiological parameters when entered by patients using telepharmacy technology. However, more than half of the participants reported that lack of reimbursement and evidence‐based studies might hinder the use of telemedicine technology to deliver remote clinical services. Conclusion The need for implementing telepharmacy technology has been further boosted because of its noticeable benefits in promoting convenient healthcare services remotely in emergency situations.

Aims The aim of the current study was to examine the following hypotheses: 1. Mothers who breastfeed their infants from 2 to 12 months of age or who use a mixed-feeding method after birth will demonstrate greater attachment toward their infants than mothers who only formula-feed their infants, as measured by the Maternal Attachment Inventory (MAI). 2. A difference in maternal attachment levels will be observed between mothers who exclusively formula-feed their infants and those who exclusively breastfeed their infants from 2 to 12 months of age, as measured by the MAI inventory, controlling for infant temperament. Method A cross-sectional, descriptive, comparative method was applied in different healthcare centers in Jordan from May 2016 to August 2016 in which the MAI inventory was employed to assess 258 Arabic-speaking mothers. One-way analysis of variance was used to detect the differences in maternal attachment between mothers using different feeding methods. Results The findings showed significant differences in maternal attachment between exclusive breastfeeding and exclusive formula-feeding mothers, and mixed-feeding mothers at 2 months (F = 24.36, P, Highlights • Poor maternal attachment could lead to insecure infant attachment. • Healthcare providers need to understand the influences of some factors on maternal attachment. • Significant difference in maternal attachment between the breastfeeding and the formula-feeding mothers.

Translocation renal cell carcinoma (tRCC) is an aggressive and poorly-characterized subtype of kidney cancer driven by MiT/TFE gene fusions. Here, we define the landmarks of tRCC through an integrative analysis of 152 tRCC patients identified across multiple genomic, clinical trial, and retrospective cohorts. Most tRCCs harbor few somatic alterations apart from MiT/TFE fusions and homozygous deletions at chromosome 9p21.3 (19.2% of cases). Transcriptionally, tRCCs display a heightened NRF2-driven antioxidant response that is associated with resistance to many targeted therapies. Consistently, we find that outcomes for tRCC patients treated with vascular endothelial growth factor receptor inhibitors (VEGFR-TKI) are worse than those treated with immune checkpoint inhibition (ICI). Multiparametric immunofluorescence confirmed the presence of CD8 + tumor-infiltrating T cells compatible with a clinical benefit from ICI and revealed an exhaustion immunophenotype distinct from clear cell RCC. Our findings comprehensively define the clinical and molecular features of tRCC and may inspire new therapeutic hypotheses.

Background The acceleration in the number of undergraduate students experiencing mental illness necessitates action to prevent negative prognosis. Aim This study aims to examine the impact of gender on the attitude of undergraduate nursing students toward seeking professional psychological help. Method The study used a pretest-posttest design in nursing school in Hashemite University. Students were followed up approximately 4 months after completing a psychiatric course to determine whether their attitude toward seeking professional psychological help had changed. Results There were significant differences among females in respect of seeking help from professionals between pretest and posttest for overall score of seeking help from professionals, confidence in helper, recognition of need for help, and openness with professional. Conclusion/implications for future studies The findings offer strong evidence on the importance of including a psychiatric course in nursing degree programs to enhance the attitude of undergraduate nursing students toward professional psychological help and overall health and well-being. The findings of this study regarding the impact of an educational psychiatric program provide future healthcare providers with an evidence-based intervention. This intervention can be implemented in all healthcare facilities and may lead to a significant change in mental health practices in Jordan, which is the inclusion of the education within routine care., Highlights • The acceleration in the number of undergraduate students experiencing mental illness is alarming. • Mental illnesses have an impact on physical, social, and personal functioning among undergraduate students. • There were significant differences among females in respect of seeking help from professionals.

Background The development of gene editing technologies is very promising for the treatment of genetic diseases. However, gene editing can be also used to enhance the characteristics of healthy individuals. This study aims to determine ethical challenges that may face the constitution of gene editing in the Middle East and North Africa (MENA) region. Methods An online discussion forum about the ethical challenges of applying gene editing technologies was held. The participants were a group of researchers (n = 28) from the MENA region. Results Most of the participants agreed on the importance of gene editing for the treatment of genetic diseases. However, participants had concerns regarding the use of gene editing to enhance the characteristics of healthy individuals such as athletic abilities and intelligence. Among ethical issues that were raised are justice, harm, beneficence, discrimination, conflict with religion and culture, and lack of regulations. Conclusion Several ethical issues were raised for using gene editing technologies based on the perception of biomedical researchers from the MENA region. Therefore, the scientific community and other interested bioethical, social, legal, and governmental parties should be provided with a detailed guide from the scientists in this area for future uses of this technology., Gene editing, MENA, Ethics, Gene therapy, Enhancement.

Objective This study aims to review the literature regarding epidural analgesia and related ethical issues among pregnant women. Method The authors were searched many electronic databases (CHINAL, Ovid Midline, Pub MED and Google Scholar, Science Direct Database, Biomed) under the following keywords (Informed consent, epidural analgesia, pregnant women, and antenatal period). The several quantitative studies published in English were reviewed and analyzed. The authors were analyzed the studies using a literature review matrix subheading to author, years published, type of study, variables, design and methodology, finding, conclusion, limitations for practices and limitations for studies. Results The themes that emerged from the literature review were: difference between patient and provider in perceptions of informed consent toward EA during childbirth process; factors affecting the women choice of using EA during childbirth process and awareness regarding using of EA in childbirth among women in antenatal clinics. Conclusion The process of signing of informed consent for EA in women during childbirth is linked to many ethical responsibilities from women and healthcare providers. The informed consent practice can be enhanced by putting greater emphasis on antenatal information, providing suitable timing of information and developments in recent methods of information release and transfer., Highlights • Labor pain is considered an important issue that women experience at the end of pregnancy. • Informed consent practice can be enhanced by placing superior emphasis on antenatal information. • The main reasons for avoiding EA are lack of knowledge and awareness and misconceptions about EA.

This study aims to compare the attitudes of nursing students in Jordan toward seeking professional psychological help, before and after taking part in a mental health course. A pretest-posttest design was used to assess the attitudes of 205 nursing students attending a state-run university in Zarqa City, Jordan. A significant difference was found in Attitudes Toward Seeking Professional Psychological Help subscales before and after the course, implying that it would be useful for policy makers to provide periodic comprehensive mental health education and courses for practicing health care providers.

Medicinal chemistry (MC) is an indispensable component of the pharmacy curriculum. The pharmacists’ unique knowledge of a medicine’s chemistry enhances their understanding of the pharmacological activity, manufacturing, storage, use, supply, and handling of drugs. However, chemistry is a challenging subject for both teaching and learning. These challenges are typically caused by the inability of students to construct a mental image of the three-dimensional (3D) structure of a drug molecule from its two-dimensional presentations. This study explores a prototype virtual reality (VR) gamification option, as an educational tool developed to aid the learning process and to improve the delivery of the MC subject to students. The developed system is evaluated by a cohort of 41 students. The analysis of the results was encouraging and provided invaluable feedback for the future development of the proposed system.

There is a dearth of research that investigates the relationship between religiosity and stigma of mental illnesses by the context of Jordanian culture. So, this study aimed to describe the relationship between religiosity and stigma against mental illnesses as described by undergraduate university students in Jordan. This study design was descriptive correlations study among 338 University Students, undergraduate students in Jordan. The findings indicate there is a significant correlation (r = - 0.154, p < 0.05) between stigma toward patient with mental illnesses and religiosity. The higher religiosity score is associated with more negativity toward stigma of patient with mental illnesses. Also, the findings indicated there was a significant difference between medical and non-medical student's specialty area and stigma toward patients with mental illnesses (t = 111.14, p = 0.01). Non-medical students reported more stigma for patients with mental illnesses. Stigma against patient with mental illnesses should be addressed at different levels. Cultural competency curriculum should be established for medical and non-medical students to assure more acceptance attitudes and avoidance of stigma against patients with mental illnesses., Mental, Illnesses, Stigma, Religiosity, University, Undergraduate, Students.

Purpose The aim of this study was to examine the medical student knowledge regarding pediatric palliative care (PPC) and determine the predictors of knowledge among them toward PPC. Methods A cross-sectional engaging study was directed with 326 medical students studying in Jordanian universities. A campaign utilizing online social media and Web-based software were executed to promote, enlist, overview undergraduate medical students, and gather information for this study. The authors employed four techniques to select undergraduate medical students on paid-promoted Facebook, personal messages, and postings in clinical forums. Results The results of this study showed that medical students have inadequate knowledge about pediatric palliative care in Jordan. The only factors that predict the knowledge toward PPC is gender. Conclusion it should build the medical students' information on pediatric palliative care. The pointer was not significant in the multivariate studies, and that vicariate studies indicated no distinction in the overall scores on either test among the nonmedical students, Training projects ought to be established and delivered to pediatric medical students to improve their knowledge about pediatric palliative/palliative consideration., Highlights • Healthcare experts have revealed that they feel overwhelmed while experiencing children’ death. • Medical students have inadequate knowledge about pediatric palliative care in Jordan. • Training projects ought to be established and delivered to pediatric medical students to improve their knowledge about pediatric palliative/palliative consideration.

Sawsan Abuhammad,1 Suhaib Muflih,2 Karem H Alzoubi,2 Besher Gharaibeh3 1Department of Maternal and Child Health, Jordan University of Science and Technology, Irbid, 22110, Jordan; 2Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan; 3Department of Adult Health, Jordan University of Science and Technology, Irbid, 22110, JordanCorrespondence: Sawsan Abuhammad Email Shabuhammad@just.edu.joBackground: Nurses and Doctor of Pharmacy (pharmD) must communicate and properly documented the do not resuscitate orders for terminally ill children and their relatives. They also have to offer excellent care including more family support, assisting the child with terminally ill disease in passing on peacefully, and preventing unnecessary cardiopulmonary resuscitation. This research was aimed to survey attitudes of nursing and pharmD undergraduate students about the “do not resuscitate” order for children with terminally ill diseases.Methods: A cross-sectional correlational design was used to study the correlation between attitude toward DNR and demographic variables. More than 400 nursing and pharmD students from Jordan University of Science and Technology were recruited in this study. All the participating students were e-mailed information regarding the study, including the web survey link.Results: The results showed that there was a significant difference in perception toward do not resuscitate order between nursing and pharmD students (p ≤ 0.05). The pharmD students had more positive attitude toward do not resuscitate than the nursing students. Approximately, 60% of the nursing and pharmD students would disclose the need for the do not resuscitate order for children with terminally ill diseases Demographic variables were not associated with the perception toward do not resuscitate orders (p ≥ 0.05).Conclusion: This study showed that Jordanian nursing and pharmD students are willing to learn more about different aspects of do not resuscitate orders for terminally ill children. Analyzing their responses to many items showed their misconception about do not resuscitate orders for terminally ill children.Keywords: do not rusticate, cardiopulmonary resuscitation, nursing students, children, pharmD students

Background Maternal responsiveness seems to be necessary for a child to develop a safe attachment. However, even after many years of research on maternal responsiveness, only a few attempts have been made to find ways of promoting mother and child interaction. This study aimed at determining the association between maternal responsiveness and parenting self-efficacy variables and at identifying the factors that correlated with maternal responsiveness. Method A cross-sectional correlation study design was adopted and a convenience sampling method was used to recruit 213 mothers in Irbid city, Jordan from August to November 2019. The sample population filled in a sociodemographic and perinatal datasheet, the Perceived Maternal Parenting Self-Efficacy (PMP S-E) Scale and the Maternal Infant Responsiveness Instrument (MIRI). Results The results revealed a significant relationship between maternal responsiveness and PMP S-E. Other factors; besides, self-efficacy were also found to have some correlation on maternal responsiveness (B = 1.913, P = .049). Only previous experience of caring for children (B = 9.56, P = .05). Conclusion This study found that the sociodemographic factors considered in this study had an insignificant correlation on perceived self-reported maternal responsiveness. On the other hand, it did find that PMP S-E had a significant correlation on maternal responsiveness. Healthcare professionals need to recognise these variables in their endeavours to meet the needs of mothers and their newborns.

Simple Summary Cyclin-dependent kinases 4 and 6 (CDK4/6) are key enzymes controlling the cell cycle. CDK4/6 inhibitors are being tested in multiple clinical trials for a range of cancers including melanoma, and a deeper understanding of how they interact with other therapies is vital for their clinical development. Beyond the cell cycle, CDK4/6 regulates cell metabolism, which is a critical factor determining response to standard-of-care mitogen-activated protein kinase (MAPK) pathway therapies in melanoma. Here, we show that CDK4/6 inhibitors increase glutamine and fatty acid-oxidation-dependent mitochondrial metabolism in melanoma cells, but they do not alter the metabolic response to MAPK inhibitors. These observations shed light on how CDK4/6 inhibitors impinge on the regulation of metabolism and how they interact with other therapies in the setting of melanoma. Abstract Cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors are being tested in numerous clinical trials and are currently employed successfully in the clinic for the treatment of breast cancers. Understanding their mechanism of action and interaction with other therapies is vital in their clinical development. CDK4/6 regulate the cell cycle via phosphorylation and inhibition of the tumour suppressor RB, and in addition can phosphorylate many cellular proteins and modulate numerous cellular functions including cell metabolism. Metabolic reprogramming is observed in melanoma following standard-of-care BRAF/MEK inhibition and is involved in both therapeutic response and resistance. In preclinical models, CDK4/6 inhibitors overcome BRAF/MEK inhibitor resistance, leading to sustained tumour regression; however, the metabolic response to this combination has not been explored. Here, we investigate how CDK4/6 inhibition reprograms metabolism and if this alters metabolic reprogramming observed upon BRAF/MEK inhibition. Although CDK4/6 inhibition has no substantial effect on the metabolic phenotype following BRAF/MEK targeted therapy in melanoma, CDK4/6 inhibition alone significantly enhances mitochondrial metabolism. The increase in mitochondrial metabolism in melanoma cells following CDK4/6 inhibition is fuelled in part by both glutamine metabolism and fatty acid oxidation pathways and is partially dependent on p53. Collectively, our findings identify new p53-dependent metabolic vulnerabilities that may be targeted to improve response to CDK4/6 inhibitors.

Aim This study aims to explore the prevalence rates of stigma and fear among people in Jordan during COVID‐19 pandemic and to assess socio‐demographic and personal factors contributing to the prevalence rates of fear and stigma among people in Jordan during COVID‐19 pandemic. Method Cross‐sectional descriptive design was utilized to attain the study aim. An anonymous online survey targeting people of Jordan was used and distributed to adults in Arabic language. The survey included a previously validated fear scale. Stigma was measured using developed instrument by authors. Results The prevalence of fear among study participants was 52%. In addition, the prevalence of stigma towards infected people and their contact was 64%. The predictors of stigma towards infected people with COVID‐19 and their contact were income, living area and downloaded application to trace COVID‐19 cases. Moreover the predictors of fear were income living area and downloaded application to trace COVID‐19 cases (P ≤ .001). Conclusion More than 50% of the respondents were afraid from COVID‐19 and 64% had stigma towards infected people and their contact during the COVID‐19 pandemic. The present study highlights the need for an intervention that provides psychological support to citizens during the pandemic.

Aim Mental health disorders in many countries are regarded as taboo and are often concealed. This study aimed to (a) explore students in secondary school' stigma perceptions of mental disorder; (b) examine whether there is a connection between religiosity and stigma toward people with mental illnesses; and (c) identify stigma correlates for stigma perceptions toward people with mental illnesses based on the religiosity and demographic features of the students. Method A cross-sectional correlational study was undertaken among 357 students from two high schools. The participants completed a structured research instrument that consisted of (1) a sociodemographic characteristics questionnaire, (2) a religiosity questionnaire and (3) a devaluation-discrimination scale. Results The regression model was able to forecast a moderate percentage of stigma perception variance (F = 4.74, p = .01). Gender was the only important correlate in the model at p = .05. Conclusion and implications This study found that among students in secondary school in Jordan there is an association between religiosity and stigma toward mental disorders. This result implies that there is a need to increase policy maker information about the importance of applying religious principles to decrease stigma and enhance a positive non-stigmatizing attitude toward mental disorders. Moreover, improving the curriculum content concerning the problems associated with mental ill health may allow students to gain a more precise understanding of mental disorders more generally., Stigma; Students; Mental disorder; Religiosity