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Nidal A Younes,1 Raeda AbuAlRub,2 Hussam Alshraideh,3,4 Munir A Abu-Helalah,5 Sohaib Alhamss,1 Omar Qanno’1 1Department of Surgery, Faculty of Medicine, University of Jordan, Amman, Jordan; 2Department of Community and Mental Health, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan; 3Industrial Engineering Department, Faculty of Engineering, Jordan University of Science and Technology, Irbid, Jordan; 4Industrial Engineering Department, American University of Sharjah, Sharjah, UAE; 5Department of Public Health, Faculty of Medicine, Mutah University, Alkarak, JordanCorrespondence: Nidal A Younes Email younesnidal@gmail.comBackground: Mandatory relicense of all physicians in Jordan went into effect at the beginning of May 2018. The bylaw states that all physicians should engage in Continuing Professional Development (CPD) in order to upgrade their knowledge and maintain competency as a prerequisite to renew their license every 5 years. The characteristics of effective CPD are different from one country to another. Jordan has decided to link CPD to mandatory relicense; however, no research has been done to identify the factors that influence CPD offerings, needs, practices, experiences, and effectiveness in the healthcare sector in Jordan. This paper reviews the history of CPD and CME, and the different options to upgrade and improve the competence of physicians. It explores the current practices, motivation, and barriers for physicians to get engaged in CPD activities in Jordan.Purpose: The purpose of this research was to provide a better understanding of the state of CPD in the healthcare sector in Jordan with a view to informing the development of Jordan’s first CPD framework. The findings of this research will provide policymakers with baseline information concerning current CPD practices, experiences, and attitudes of physicians towards CPD, and enablers and contributors to effective CPD in Jordan.Methods: Stratified clustered self-selected participants that represented physicians working at all healthcare sectors in Jordan were used in this study. A structured pre-tested self-reported questionnaire was used to collect the data. A total of 457 physicians were included in the sample according to one-proportion sample size calculation method, and they were distributed among the healthcare sectors based on their shared proportions.Conclusion: Despite considerable evidence supporting the role of CPD in maintaining competency of physicians, participating in CPD activities in Jordan is compromised by lack of mandatory laws and barriers related to staff shortage, heavy workload, limited funds, lack of time, and cost. Personal interests and career progression are the top motivators for CPD. Most Jordanian physicians are interested in CPD activities related to health/medical informatics and enhancing their skills in evidence-informed practice. We recommend that future interventions and health policy directions should be informed by these findings in order to optimize uptake of CPD programs in Jordan.Keywords: continuing professional development, continuing medical education, CPD, CME, accreditation, re-license, Jordan

Background: Several recent studies have highlighted the need for more evaluation of the impact of COVID-19 infections and vaccines on the reproductive system and menstruation. This study aimed to assess the impact of COVID-19 infection and vaccines on menstrual symptoms., Methods: A cross-sectional survey utilizing face-to-face interviews from January 1 to 31 March 2022 was conducted in the city of Al-Karak in southern Jordan. The questionnaire included sociodemographic characteristics, medical and reproductive history, the contraceptive method used if any, menstrual cycle (MC) status, previous medical and drug history, and the impact of infection and vaccination on the MC., Results: The study questionnaire was completed by 400 participants with a mean age of 32.1±12.6 years. Regarding the history of COVID-19 infections, 33.8% of the participants reported a history of confirmed COVID-19 infections, 77.8% of them did not report any menstrual changes following the infection, while the remaining 22.2% reported changes in menstruation. The most commonly reported post-COVID-19 manifestations were irregular (27.6%) and light menstrual cycle (MC) (24.15) or dysmenorrhea (24.1%). Heavy menstruation was reported by 17.2% of participants post-COVID-19 infection. Two-thirds of the study participants (66.6%) reported no changes in the MC following the administration of the COVID-19 vaccine. The most reported symptoms for those who experienced changes in the MC following the vaccination were irregular cycle (13.1%), heavy menstruation (7%), and light menstruation (7%). Other reported symptoms were dysmenorrhea (4.6%), intermenstrual bleeding (1.2%), and amenorrhea (0.5%)., Conclusion: This study revealed minor changes in the MC following COVID-19 infections and administration of the COVID-19 vaccine. These findings are consistent with published reports. It is recommended that future clinical trials for new vaccines for women of childbearing age include outcomes related to sex hormones and MC. Women should be encouraged to take the vaccines and report symptoms to healthcare professionals for further assessment., (© 2024. The Author(s).)

Introduction: Escherichia coli and Klebsiella pneumoniae are common organisms associated with urinary tract infections. The COVID-19 pandemic has had a negative impact on antibiotics misuse globally. This study analyzed the antibiotic susceptibility for these two pathogens isolated from urine samples during the period of 18 months before and after the COVID-19 pandemic., Methodology: This retrospective study was conducted in Al-Karak government referral and teaching hospital in Jordan. The study included two groups; group A included urine samples from September 2018 to March 11, 2020, while group B from March 12, 2020 to August 2021. Samples were analyzed using the automated VITEK 2 system and the analysis of results was done using the WHONET version 5.6., Results: A total of 642 E. coli and 113 K. pneumoniae were isolated and analyzed. The antibiogram showed a significant overall increase in antibiotic susceptibility of both bacteria during the pandemic period (group B). The sensitivity has significantly increased by 75% (15/20) and 50% (10/20) for all antibiotics used for E. coli and K. pneumoniae respectively. On the other hand, E. coli showed a significant increase in resistance to ceftriaxone (13.4%) and gentamicin (6.4%). A similar trend of an increase in resistance to gentamicin (17.4%) was also noticed among K. pneumoniae isolates., Conclusions: The antimicrobial susceptibility pattern for urine isolates showed an increased overall sensitivity and an increased resistance to ceftriaxone and gentamicin during the pandemic period. Our results highlight the need for revising and updating the antimicrobial stewardship programs post-COVID pandemic utilizing local data., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2023 Mohammad A Abu Lubad, Munir A Abu-Helalah, Tahany S Al-Hajaia, Kholoud A Al-Hutaibat, Amin A Aqel, Hamed Alzoubi.)

Background: The availability of COVID-19 vaccines worldwide necessitates measuring healthcare workers' (HCWs') willingness to recommend or receive these vaccines. Therefore, we conducted a local study in Jordan to assess HCWs' willingness to recommend or receive a third dose of a COVID-19 vaccine and the predictors of such a decision. A cross-sectional study investigated Jordanian HCWs' willingness regarding a third dose of a COVID-19 vaccine using a self-administered online questionnaire through WhatsApp, a mobile phone application. A total of 300 HCWs participated in the current study. Of these HCWs, 65.3% were physicians, 25.3% were nurses, and 9.3% were pharmacists. HCWs' overall willingness regarding a third vaccine dose was 68.4% (49.4% certainly and 19.0% probably), whereas the overall willingness of HCWs to recommend a third dose to their patients was 73.3% (49.0% certainly and 24.3% probably). Males had significantly higher willingness than females (82.1% vs. 60.1%, p < 0.05). Physicians reported more willingness than nurses and pharmacists. HCWs' willingness was not significantly affected by direct contact with a patient infected with COVID-19 or by a personal history of COVID-19 infection. Only 31% of HCWs were certainly willing to recommend the vaccine to their patients with chronic diseases, and only 28% of the participants were certainly willing to recommend it to people aged 65 or older. HCWs' willingness to receive a third dose of a COVID-19 vaccine is limited in Jordan. This has affected their certainty in recommending this vaccine to their patients or people older than 60. Decision-makers and health-promotion programs in Jordan should focus on addressing this public health problem.

Objective: To examine the relationship between overall level and source-specific work-related stressors on medication errors rate., Design: A cross-sectional study examined the relationship between overall levels of stress, 25 source-specific work-related stressors and medication error rate based on documented incident reports in Saudi Arabia (SA) hospital, using secondary databases., Setting: King Abdulaziz Hospital in Al-Ahsa, Eastern Region, SA., Participants: Two hundred and sixty-nine healthcare professionals (HCPs)., Main Outcome Measures: The odds ratio (OR) and corresponding 95% confidence interval (CI) for HCPs documented incident report medication errors and self-reported sources of Job Stress Survey., Results: Multiple logistic regression analysis identified source-specific work-related stress as significantly associated with HCPs who made at least one medication error per month (P < 0.05), including disruption to home life, pressure to meet deadlines, difficulties with colleagues, excessive workload, income over 10 000 riyals and compulsory night/weekend call duties either some or all of the time. Although not statistically significant, HCPs who reported overall stress were two times more likely to make at least one medication error per month than non-stressed HCPs (OR: 1.95, P = 0.081)., Conclusion: This is the first study to use documented incident reports for medication errors rather than self-report to evaluate the level of stress-related medication errors in SA HCPs. Job demands, such as social stressors (home life disruption, difficulties with colleagues), time pressures, structural determinants (compulsory night/weekend call duties) and higher income, were significantly associated with medication errors whereas overall stress revealed a 2-fold higher trend., (© The Author(s) 2018. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Purpose: Colorectal cancer (CRC) ranked first among cancers reported in males and second among cancers reported in females in Jordan in 2010. There has been no specific CRC-control programme in Jordan. Additionally, there has been no published study from Jordan or its neighbours on patient delays in presentation, diagnosis or treatment. Therefore, we conducted this study to assess these important quality indicators aiming to improve prognosis for CRC and to provide baseline data for future health promotion programmes for CRC in Jordan., Methods: This project was a cross-sectional study on CRC patients at Al Bashir Hospital, Ministry of Health, and at the Military Oncology Centre of the Jordanian Royal Medical Services., Results: The total number of participants was 189. The proportion of patients with presentation delay, diagnosis delay or treatment delay was 33.9, 68.1 and 32.6%, respectively. The main reasons reported for delay in presentation were lack of knowledge that symptoms were suggestive of cancer (58.5%), misdiagnosis by physicians or pharmacists (38.4%) or the patient did not want to visit a doctor (3.1%). Predictors of delay and mean time for presentation, diagnosis and treatment were identified., Conclusions: Our results revealed that CRC patients in Jordan experience delays in presentation, Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation diagnosis, and, to a lesser degree, in treatment. This could justify the advanced stages at diagnosis and poor outcomes for CRC patients. Our findings provide baseline information for future CRC-control programmes in Jordan. We recommend that CRC prevention programmes in Jordan focus on early detection of CRC and target both patients and physicians.

Objectives: The aims of this study are to assess cigarette and hookah smoking rates amongst adult population in Jordan and to determine predictors of smoking status. Selected beliefs, perceptions and attitudes toward cigarettes and hookah smoking were also assessed., Methods: This cross-sectional study was conducted in five regional governorates of Jordan through face-to-face interviews on a random sample of adult population aged 18-79 years. Data was collected using a piloted questionnaire based on the Global Adult Tobacco Questionnaire., Results: The overall prevalence of cigarette smoking in our sample (869) was 59.1 % amongst males and 23.3 % amongst females, while the overall prevalence of hookah smoking was 18.9 % amongst males and 23.1 % amongst females. Leisure and imitation were the most commonly reported reasons for smoking. Regardless of smoking status, people were aware of health risks associated smoking and also had negative perceptions toward smoking., Conclusions: Smoking rates for both genders have reached alarmingly high rates in Jordan. There is an urgent need for a comprehensive national programme to target the country's growing burden of smoking. Suggestions on leisure time activities should be included in such programmes.

Background: Breast cancer is the most common type of cancer in Jordan. Current efforts are focused on annual campaigns aimed at increasing awareness about breast cancer and encouraging women to conduct mammogram screening. In the absence of regular systematic screening for breast cancer in Jordan, there is a need to evaluate current mammography screening uptake and its predictors, assess women's knowledge and attitudes towards breast cancer and screening mammograms and to identify barriers to this preventive service., Materials and Methods: This cross-sectional study was conducted in six governorates in Jordan through face- to-face interviews on a random sample of women aged 40 to 69 years., Results: A total of 507 participants with mean age of 46.8±7.8 years were interviewed. There was low participation rate in early detection of breast cancer practices. Breast self-examination, doctor examination and periodic mammography screening were reported by 34.9%, 16.8% and 8.6% of study participants, respectively. Additionally 3.8% underwent breast cancer screening at least once but not periodically, while 87.6% had never undergone mammography screening. Reported reasons for conducting the screening were: perceived benefit (50%); family history of breast cancer (23.1%); perceived severity (21.2%); and advice from friend or family member (5.8%). City residents have shown higher probability of undergoing mammogram than those who live in towns or villages. Results revealed negative perceptions and limited knowledge of study participants on breast cancer and breast cancer screening. The most commonly reported barriers for women who never underwent screening were: fear of results (63.8%); no support from surrounding environment (59.7); cost of the test (53.4%); and religious belief, i.e. Qadaa Wa Qadar (51.1%)., Conclusions: In the absence of regular systematic screening for breast cancer in Jordan, the uptake of this preventive service is very low. It is essential for the country of Jordan to work on applying regular systematic mammography screening for breast cancer. Additionally, there is a need for improvement in the current health promotion programmes targeting breast cancer screening. Other areas that could be targeted in future initiatives in this field include access to screening in rural areas and removal of current barriers.

The aim of this cross-sectional study was to assess the knowledge about epilepsy and the attitudes toward people with epilepsy (PWE) and their predictors among university students in Jordan. A self-administered questionnaire was distributed in three of the largest public universities in Jordan, and a total of 500 questionnaires were collected from each university. The number of students who reported that they had heard or read about epilepsy was 1165 (77.6%), and their data were analyzed. A significant proportion of students thought that epilepsy could be caused by the evil spirit (31.5%) and the evil eye (28.1%) or that it could be a punishment from God (25.9%). Epilepsy's most commonly reported treatment methods were the Holy Quran (71.4%), medications (71.3%), and herbs (29.3%). The most common negative attitudes toward PWE were that the students would refuse to marry someone with epilepsy (50.5%) and that children with epilepsy must join schools for persons with disabilities (44.4%). Male students, students of humanities, and students with a low socioeconomic status tended to have more negative attitudes toward PWE. In conclusion, many students have misconceptions about the causes, treatment, and nature of epilepsy, and students have moderate negative attitudes toward PWE. Universities should have health promotion programs to increase awareness of their students about major public health problems such as epilepsy., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Colorectal ranked first among cancers reported in males and ranked second amongst females in Jordan, accounting for 12.7% and 10.5% of cancers in males and females, respectively. Colorectal cancer patients can suffer several consequences after treatment that include pain and fatigue, constipation, stoma complications, sexual problems, appearance and body-image concerns as well as psychological dysfunction. There is no published quantitative data on the health-related quality of life and psychological wellbeing of Jordanian colorectal cancer survivors., Method: This project was a cross-sectional study of colorectal cancer survivors diagnosed in 2009 and 2010. Assessment was performed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), the colorectal cancer specific module (EORTC QLQ-CR 29) and the Hospital Anxiety and Depression Scale (HADS). Data on potential predictors of scores were also collected., Results: A total of 241 subjects completed the study with mean age of 56.7±13.6. Males represented 52.3% of study participants. A majority of participants reported good to high overall health; the mean Global health score was 79.74± 23.31 with only 6.64% of study participants scoring less than 33.3%. The striking result in this study was that none of the study participants participated in a psychosocial support group; only 4 of them (1.7%) were even offered such support. The mean scores for HADS, depression score, and anxiety score were 8.25±9, 4.35±4.9 and 3.9±4.6, respectively. However, 77.1% of study participants were within the normal category for the depression score and 81.7% were within this category for anxiety score; 5.4% of participants had severe anxiety and 5.4% of them had severe depression., Discussion: Patients with colorectal cancer in Jordan have a good quality of life and psychological wellbeing scores when compared with patients from western countries. None of the colorectal cancer patients managed at the Ministry of Health received any formal counselling, or participated in psychological or social support programmes. This highlights the urgent need for a psychosocial support programme, psychological screening and consultations for patients diagnosed with colorectal cancer at the Ministry of Health Hospitals.