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Abdullah Alghamdi,1 Abdulmalak Abdullah Alsaleh,2 Omar Abdulaziz Alfozan,2 Rayan Qutob,1 Abdullah Alaryni,1 Abdullah Bukhari,1 Osamah A Hakami,1 Bassam Abdulaziz Alhusaini,2 Saad Abdullah Alzmamy,2 Fadhah Saud Alhudayris,2 Lama Khalid Alshuaibi,2 Ahad Marei Alenazi,2 Lama Shaya Alhosaini,2 Najd Khalid Aljarba,2 Shahad Hameed AlShammari2 1Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia; 2Faculty of medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi ArabiaCorrespondence: Bassam Abdulaziz Alhusaini, Faculty of medicine, Imam Mohammad Ibn Saud Islamic University, 7544 Othman Bin Affan Road Al-Nada, Riyadh, 13317, Saudi Arabia, Tel +966557818206, Email Bam.h98s@gmail.comBackground: Organ donation is a lifesaving option to rescue many patients with end-stage organ failure from possible morbidities and mortalities. Unfortunately, due to a shortage of donors, many patients suffering from their illnesses are waiting for an organ. This study aimed to determine the awareness, attitude, and beliefs toward organ donation among the Saudi population.Patients and Methods: This is an online cross-sectional survey that was conducted in Saudi Arabia between July and September 2022. A self-administered questionnaire was distributed to the general public using an online platform. The questionnaire consists of two sections: the first is about demographic data, and the second is about questions to assess awareness, attitude, and beliefs regarding organ donation. The Chi-squared test was used to examine the differences in participants’ awareness, attitude, and beliefs towards organ donation. A binary logistic regression analysis was used to identify predictors of a positive attitude towards organ donation.Results: A total of 3507 individuals participated in this study. Around 68.1% were aged between 18 and 30 years. Twenty-four percent of them knew of the legislative body for organ donation; 58.5% believed that organ donation should be promoted; and 66.1% had a positive attitude toward donating body organs. Younger age (31– 50 years), male gender, being unemployed or working in a government job, and being married were factors that decreased the likelihood of having a positive attitude towards organ donation.Conclusion: Although there was a positive attitude and belief about organ donation, awareness was suboptimal. Younger age, male gender, being unemployed or working in a government job, and being married were factors that decreased the likelihood of having a positive attitude towards organ donation. It is necessary to address the gaps in knowledge, and social media as well as mass media may have an important role in bridging the gaps.Keywords: organ donation, attitude, knowledge, belief, public

Rayan Qutob,1,2 Alanoud Hassan A Alkhannani,1 Turki Yazeed Alassaf,1 Saad Othman Alhokail,1 Ghassan Abdullah Bagazi,1 Abdulmalak Abdullah Alsaleh,1 Mashael kamel alqarni,1 Yousef Alammari,1 Khalid Al Harbi,1 Alyaa Elhazmi,3 Abdullah Ibrahim Bukhari,1 Abdullah Alaryni,1 Abdullah Alghamdi,1 Osamah A Hakami1 1Faculty of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia; 2Adult Critical Care Department, Dr. Sulaiman Al-Habib Medical Group, Riyadh, Saudi Arabia; 3College of Medicine, AlFaisal University, Riyadh, Saudi ArabiaCorrespondence: Alanoud Hassan A Alkhannani, Faculty of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia, Tel +966 545436837, Email alanoudhk1998@gmail.comObjective: To determine physicians’ knowledge of abdominal compartment syndrome and intra-abdominal hypertension in Saudi Arabia.Methods: A cross-sectional online survey study was conducted on physicians in Saudi Arabia between March and August 2022. A previously developed questionnaire was adapted and used in this study. The survey instrument investigated the knowledge and management of intra-abdominal hypertension and abdominal compartment syndrome among physicians. Logistic regression was used to identify predictors of being knowledgeable about abdominal compartment syndrome and intra-abdominal hypertension.Results: A total of 266 physicians participated in this study. Around one-fifth (21.8%) the study participants were ICU physicians and 25.0% reported that they practice internal medicine. Intra-abdominal hypertension (IAH) and the impact of increased intra-abdominal pressure (IAP) on organ function were terms that the majority of research participants (70.3%) reported they were familiar with. A similar percentage (73.7%) reported that they are familiar with abdominal compartment syndrome (ACS). Around 43.0% of the study participants reported that they do not know how to measure IAP. The most frequently reported (13.5%) intervention in the treatment of IAH and ACS was the use of inotropes or vasopressors. The study participants showed a weak level of knowledge of ACS and IAH with a median score of 3.00 (IQR: 5.00– 2.00), which represents 27.3% of the maximum attainable score. Physicians working at hospitals with 20– 50 ICU beds were 41.0% (odds ratio: 0.59 (CI: 0.37– 0.96)) less likely to be knowledgeable about intra-abdominal hypertension and abdominal compartment syndrome (p≤ 0.05).Conclusion: Physicians demonstrated a low level of IAP and ACS knowledge. To increase the safety of medical practices and enhance clinical outcomes for patients, awareness should be raised about the proper diagnosis and management of IAP and ACS. Future research should focus on developing effective educational strategies to improve physicians’ understanding of IAP and ACS.Keywords: abdominal compartment syndrome, intra-abdominal hypertension, intra-abdominal pressure, knowledge, physicians, Saudi Arabia

Osamah Ahmad Hakami,&ast; Refah Asheer Alsubaie,&ast; Bayan Abdulhadi Albaqami, Haifa Matar Almutlaq, Nourah Mushabab Alqahtani, Manal Alkhonezan, Farah Fahad Almuqrin, Abdullah Hussien Alghamdi, Abdullah Abdulaziz Alaryni, Rayan Abubakker Qutob Faculty of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia&ast;These authors contributed equally to this workCorrespondence: Refah Asheer Alsubaie, Faculty of medicine, Imam Mohammad Ibn Saud Islamic University, 7544 Othman Bin Affan Road Al-Nada, Riyadh, 13317, Saudi Arabia, Tel +966 50 255 2509, Email raalsubaie18@sm.imamu.edu.saBackground: Helicobacter pylori (H. pylori) is a key pathogen causing several gastrointestinal diseases. Fortunately, H. pylori infection is treatable, which can lower its comorbidities. However, data assessing physicians’ awareness of H. pylori is lacking in Saudi Arabia.Objective: To assess the knowledge and awareness of physicians of different specialties who practice in Saudi Arabia about H. pylori infection.Methods: This is a cross-sectional study conducted between May and September 2022 on physicians across all regions in Saudi Arabia using a validated online questionnaire covering their knowledge and awareness of H. pylori infection. An independent t-test, one-way ANOVA, and Games-Howell as a post hoc test were used to analyze the data. A General Linear Model was also employed to determine significant predictors among the variables reliant on H. pylori awareness.Results: The results showed that the mean awareness score of 474 physicians was 76.99± 6.9, indicating that participants had sufficient knowledge about H. pylori infection. In general, the internal medicine specialists (28.3%) had better awareness of H. pylori infection than the other specialties. Moreover, the university hospital sector performed the best, scoring 80.68± 13.3, and the southern region had the highest-ranked physicians with a score of 81.56 ± 13.7 in terms of H. pylori awareness. Furthermore, the general linear model revealed a statistical significance (p< 0.05) for the following demographic aspects concerning H. pylori awareness: the physicians’ age group of 30– 39 years, duration of experience of 11– 15 years, the hospital sectors of Nation Guards (NGH) and Security Forces (SFH), and the southern and central regions of practice in Saudi Arabia.Conclusion: Physicians in Saudi Arabia have relatively sufficient awareness of H. pylori; however, they are highly influenced by age, years of experience, the hospital sector involved, and the region where the physicians practice.Keywords: H. pylori, awareness, doctors, internal medicine, gastroenterology

Aims. Several food poisoning outbreaks in Jordan were due to Salmonella species isolated from chicken shawerma. This study aimed to assess the food safety knowledge among chicken shawerma food handlers in Jordan. Methods. Forty chicken shawerma restaurants in Amman were selected randomly and 120 food handlers (Egyptians 53%, Jordanians 26% and Syrians 19%) were interviewed using a structured questionnaire. Descriptive and multivariate data analysis was conducted to assess their knowledge about food safety. Results. Low overall mean score of food safety knowledge (40%); the mean percent of correct answers about transportation, receiving of chicken shawerma, storage, preparation, selling, and controlling microorganisms were: 63%, 54%, 45%, 31%, and 26%, respectively. Ninety percent of the participants had no previous training in food safety concepts. Better food safety knowledge was significantly associated (p > 0.05) with higher educational levels, receiving special training in food safety and having a Jordanian nationality. Conclusions. This study recommends establishing a comprehensive food safety program in Jordan to build the capacity of the food handlers and enforce periodic evaluation of their food safety knowledge and evidence-based best practices. [ABSTRACT FROM AUTHOR]

This qualitative study was carried out to understand the meaning that Jordanian men attach to birth-spacing/family planning and to identify their attitudes and practices regarding contraceptives. Six focus group discussions were conducted over a 3-month period starting April 1996, with each group containing 6-10 men. The sample consisted of Jordanian men residing in Amman. Education, social class, and marital status stratified men's selection. The discussions were moderated by a social psychologist of the same sex. With respondents' consent, data gathered in the discussion groups were tape-recorded, transcribed, and critically analyzed using the content analysis method. The researchers found that there was a consensus among all men about the link between the concept of birth-spacing/family planning and the concept of better health for the mother and the child. Yet, the practice of contraception was influenced by some religious and cultural beliefs including that of 'RIZK' (or fortune) which comes when the child is born. Moreover, some knowledge deficits concerning modern methods of contraception, and their side effects in particular, were noted. Some unfavorable attitudes of men for themselves using male contraceptives were also noted. Most men in the study indicated that spousal communication takes place on issues related to family planning, but the final decision is, in most cases, left to the husband alone (the head of the house). The demand for an increasing number of male children and the resistance of males to use condoms were among the most prevalent unexpected phenomena noticed in this study. The study concludes by recommending that special attention be directed to males when delivering family planning services. [ABSTRACT FROM AUTHOR]

RATIONALE: Most estimates of reproductive morbidity in a community are derived from health service-based studies. However, these numbers do not reflect the actual magnitude of the problem because of barriers to health care and differences in health-seeking behaviour. As a result, this study uses an alternative method to measure reproductive morbidities amongst women in a Jordanian community. OBJECTIVE: To assess the validity of a home-based pelvic examination in detecting signs of reproductive morbidity when compared with a clinic-based examination. METHODOLOGICAL DESIGN: Descriptive study in which women were randomly selected from the study area to participate in the study. RESEARCH METHODS: Three hundred and seventy nine women, 18 years and above were randomly selected, and general and pelvic examinations were conducted in each woman's home. Thirty-two of these women were again randomly selected and consented to a second pelvic examination in a clinical setting. INSTRUMENTS: Two trained female obstetricians conducted the pelvic examination which included examination of the vulva, examination of the vagina and a bimanual examination. Outcome measures. Strength of association between the presence or absence of physical signs of reproductive morbidity detected by the home-based pelvic examination and the same signs identified by the clinic-based examination, deemed in this study as the 'truth'. RESULTS: The overall sensitivity, specificity, positive and negative predictive values of the home-based pelvic examination were 66, 86, 69 and 84%, respectively. STUDY LIMITATIONS: The sample size was small, so further studies are recommended to replicate the findings here. CONCLUSIONS: Results suggest home-based pelvic examinations can be used in population-based studies for a comprehensive assessment of women's reproductive morbidities. [ABSTRACT FROM AUTHOR]

The study aimed at examining the effects of type of hospital and health insurance status on hospital length of stay for three identified medical and surgical conditions. Medical records of 520 patients for the year 1991 were reviewed in one public and one private hospital. Comparison of hospital length of stay for the private (n=185) versus public sector (n=335) was carried out. The effect of presence of health insurance (n=189) and the lack of it (n=325) was also studied. It was found that the average length of stay in the public hospital was significantly longer than the private one (3.3 versus 2.7 days). In addition, insured patients had significantly longer hospital length of stay (3.3 versus 3.0 days). The results of the multivariate analysis showed that after socioeconomic factors and clinical conditions of patients were adjusted for, the influence of hospital type and health insurance on hospital length of stay was about one day. The paper also discusses the need to base hospital cost-containment strategies on studies of hospital behaviour and performance. [ABSTRACT FROM PUBLISHER]

This article delineates a conceptual model for defining and measuring quality in prenatal services. It addresses three issues related to women's health: (a) the emerging interest in reproductive health as a concept that encompasses the full range of women's needs, versus the more narrow concept and approach of traditional maternal and child health services; (b) the importance of prenatal services within the context of reproductive health, particularly in developing countries; and (c) the positive role that quality plays in promoting women's health. It then proposes a model for defining and measuring quality in prenatal services, styled after Donabedian's work and informed by Bruce's framework. It assesses the quality of prenatal care in terms of five elements: management, pregnant woman-provider relations, technical competence, information transmission, and continuity of care. The framework was tested in the city of Irbid, Jordan, in 1992. Findings are summarized, and recommendations for future work as discussed. [ABSTRACT FROM AUTHOR]

Background: Health services should anticipate the changing pattern of illnesses associated with population aging to promote healthy aging., Aim: We aimed to evaluate health indices and chronic illnesses and their relationship with functional independence in community Syrian refugees & Jordanian elderly., Methods: A stratified sample of 1,718 community older adults aged ≥ 60-year-old from four major Jordanian governorates was interviewed in this cross-sectional study. Katz Index of Independence in Activities of Daily Living was utilized to assess functional status. Data were analyzed using STATA 15., Results: Despite the similarities in baseline function, Syrian refugees had more multimorbidities but less active health insurance, accessibility to healthcare services and availability of medications and medical devices than Jordanians. Two-thirds had multimorbidities; with heart diseases, musculoskeletal conditions, hypertension, and diabetes being the most commonly reported chronic illnesses. Females had significantly more multimorbidities, and functional dependence, yet less education, income and accessibility to healthcare services. The mean Katz Index score was 4.99 ± 1.61. Significant predictors of functional dependence included increasing age, lower level of education, and some chronic illnesses., Conclusion: National inclusive plans to support vulnerable older adults especially refugees and older women, provide health insurance, enhance access to health care facilities, and manage chronic medical illnesses comprehensively are urgently needed to improve independence of community-living older adults and to promote healthy aging., (© 2024. The Author(s).)

Purpose: To evaluate physicians' knowledge of the ABCDE (Airway, Breathing, Circulation, Disability, Exposure) approach components., Methods: A cross-sectional study was conducted in 2023 using an online questionnaire in order to collect data about the knowledge of the ABCDE approach's components among physicians in different specialties in Riyadh, Saudi Arabia., Results: The number of participants were 165 in total and the median knowledge score for all participants was 15.0, with an associated interquartile range (IQR) of 10.0 to 20.0. Intensive Care Medicine had the highest median knowledge score of 19.0 (IQR: 12.0-21.0), followed by Internal Medicine at 17.0 (IQR: 13.0-20.0). Conversely, Cardiology and Anesthesiology showed lower scores, with medians of 8.0 (IQR: 4.0-10.0) and 7.5 (IQR: 4.0-13.5), respectively (p = 0.011). Senior Registrars demonstrated the highest median knowledge score of 20.0 (IQR: 14.0-22.0), while Fellows had the lowest at 8.5 (IQR: 7.0-13.0) (p < 0.001). Practicing for 10 to 15 years and more than 15 years having medians of 20.0 (IQR: 16.0-23.0) and 19.0 (IQR: 17.0-22.0), respectively. However, participants with less experience, working for less than 5 years, had a median score of 12.0 (IQR: 8.5-16.5) (p < 0.001)., Conclusion: Knowledge scores of physicians representing various medical specialties found diverse levels regarding the ABCDE approach. Knowledge scores were significantly influenced by the primary area of practice, level of experience, and duration worked in the profession, highlighting the need for tailored training and education across different specialties and career stages. On the other hand, future studies should concentrate on finding new factors that influence practice adherence to the ABCDE approach and tying theoretical knowledge to clinical practice., Competing Interests: The authors report no conflicts of interest in this work., (© 2024 Qutob et al.)

A caregiver attends to the needs or concerns of someone limited by disease, injury, or disability to enhance the patient's quality of life, which can be assessed in three areas: social, physical, and psychological. This cross-sectional study assessed the extent of burden experienced by the caregivers of patients undergoing hemodialysis (HD) and peritoneal dialysis (PD) therapy in King Fahad Medical City in Riyadh, Saudi Arabia. The Zarit Burden Interview Arabic Abridged version (ZBI-A) was used to assess the level of burden experienced by caregivers. The data was collected and examined by professionals using the SPSS version 23. Based on the data of 50 participants, a mean ZBI-12 score of 12.22 ± 7.2 was reported. According to the ZBI scale, "No to mild burden," "Mild to moderate burden," and "High burden" were reported as 46% (n = 23), 38% (n = 19), and 16% (n = 8) of participants, respectively. The internal consistency of the ZBI-12 scale, assessed using Cronbach's alpha, was 0.664, indicating a satisfactory level of internal consistency. It was determined that caregivers of individuals undergoing PD and HD encounter different degrees of burden, with a significant proportion of caregivers experiencing a substantial burden., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Alaryni et al.)

Background: The quality of life (QoL) of patients with end-stage kidney disease (ESKD) who undergo dialysis is a reliable predictor of their long-term survival. Hemodialysis is the most common form of kidney replacement therapy for ESKD, followed by peritoneal dialysis. This study aimed to identify the factors affecting QoL in ESKD patients treated with peritoneal dialysis (PD) or hemodialysis (HD) in Riyadh, Saudi Arabia., Methods: A cross-sectional study was conducted between June and July 2021 to assess the QoL of patients with ESKD who underwent peritoneal dialysis and hemodialysis. Patients who had been on dialysis for at least one year were included. The Arabic version of the Quality of Life Index-Dialysis (QLI-D) version III was used to measure the QoL., Results: A total of 210 patients completed the questionnaire. The overall QLI score was 21.73 ± 4.2, with subscales for health and functioning (20.35 ± 5.2), social and economic (20.20 ± 4.8), psychological/spiritual (23.94 ± 4.9), and family (24.95 ± 4.5). The QLI scores for PD and HD patients were 21.80 ± 4.4 and 21.72 ± 4.1, respectively. SOCSUB ( p = 0.031) was significantly associated with group and income, whereas QLI ( p = 0.003), HFSUB ( p = 0.013), SOCSUB ( p = 0.002), and PSPSUB ( p = 0.003) were significantly correlated with group and years of dialysis., Conclusion: The study found that patients were most satisfied with their family, health and functioning, and social/economic subscales. Income and years of dialysis were found to be predictive factors of QoL. Overall, peritoneal patients in this study demonstrated a better QoL than HD patients.

This case study highlights how a looming health crisis was leveraged as drivers for positive change for the health sector, in line with the health security agenda. In Jordan, several authorities are mandated by law to manage health emergencies. Following the declaration of outbreaks of cholera in Iraq, Lebanon and Syria, health authorities in Jordan called for a series of emergency meetings during September 2022 to discuss implications around travel and trade as well as shared waters. WHO was part of the consultations and provided guidance on the application of the International Health Regulations 2005. As the risk for cholera importation persisted, the Ministry of Health assumed its leadership role for the overall health sector response while the Jordanian Center for Disease Control assumed a coordinating function. Roles and responsibilities were enshrined in the National Cholera Preparedness and Response Plan. In consideration of the vulnerability of refugee camps and settlements towards Cholera, the existing Jordan humanitarian coordination platforms such as the Health Sector Working Group were used to share information and to coordinate activities. A whole-of-government risk assessment during December 2022 was complemented by a field visit at Zaatari refugee camp. This helped assess the risk and readiness for a cholera outbreak in Jordan and informed priority activities, such as the establishment of a national risk communication and community engagement working group as well as training on case management., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: This study aims at exploring the knowledge of women of reproductive age who underwent bariatric surgery in Jordan regarding its effect on birth outcomes., Methods: A cross-sectional study was conducted on 183 women (aged 15-49) who had undergone bariatric surgery at the Jordan University Hospital in Amman, Jordan, between 2016 and 2019, using telephone interviews with conveniently selected participants' samples. The survey tool obtained data on women's knowledge and other sociodemographic, obstetric health, and bariatric surgery information. Unfavorable birth outcomes include preterm delivery, small for gestational age, congenital abnormalities, low birth weight, and admission to the neonatal critical care unit., Results: More than half of the participants did not know about the possible unfavorable birth outcomes after bariatric surgery and related practice guidelines. This is shown in their median score of 3 (interquartile range: 2-4) out of a maximum possible score of 8. Women who had a good score (>4) had received counseling about unfavorable bariatric surgery outcomes from their surgeon ( p  < 0.013); those who had educational qualifications higher than secondary school ( p  < 0.001) as well as those who were employed ( p  < 0.008) and believed that the surgery would affect the newborn ( p  < 0.001). The median score was also unfavorably associated with the parity of the participants ( p  < 0.003)., Conclusion: The extent of knowledge regarding the unfavorable birth outcome of bariatric surgery is low among women who underwent bariatric surgery at Jordan University Hospital in Jordan. Improving health literacy and information on bariatric surgery implications on pregnancy and birth outcomes amongst women of reproductive age is a recommendation from this study., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Context: Chronic kidney disease (CKD) is characterized by the presence of kidney damage or decreased kidney function. In the Kingdom of Saudi Arabia, the prevalence of CKD is at 5.7%, which represents a high burden on health care systems., Aims: This study aimed to assess the knowledge, attitudes, and practices of high-risk patients towards prevention and early detection of chronic kidney disease in Saudi Arabia., Setting and Design: Descriptive cross-sectional study in Saudi Arabia., Methods and Material: This study was designed using a newly developed instrument, the CKD Screening Index. It was conducted from December 2021 to May 2022 by a self-administered questionnaire. The questionnaire has three parts: socio-demographic data, clinical factors, and the CKD screening index tool., Statistical Analyses Used: Independent t -test, One-Way ANOVA, LSD, Games-Howell tests., Results: Knowledge of kidney function had a significant difference across patient groups with varying employment status. Monthly income is a significant factor for the patient attitude on healthcare towards preventing kidney disease. On the other hand, educational level significantly affects the overall attitude of patients towards preventing kidney disease., Conclusion: Understanding knowledge, attitudes, and practices associated with CKD is vital to informing optimal policy and public health responses in the country.

Background: Syrian refugee women face health care disparities and experience worse pregnancy outcomes, including miscarriage. We investigated risk factors for miscarriage in Syrian refugee women living in non-camp settings in Jordan to identify targets for interventions., Methods: We analyzed data from Women ASPIRE, a cross-sectional study of gendered physical and mental health concerns of 507 Syrian refugee women (≥ 18 years old) living in non-camp settings in Jordan. We recruited women using systematic clinic-based sampling from four clinics. We limited our analyses to women who had a history of pregnancy and whose most recent pregnancy was single, took place in Jordan, and ended in term live birth or miscarriage (N = 307). We grouped the women by the primary outcome (term live birth or miscarriage) and compared the sociodemographic and clinical characteristics of the two groups. We used Pearson's χ 2 test or the Mann-Whitney U test to obtain unadjusted estimates and multivariable binomial logistic regression to obtain adjusted estimates., Results: The most recent pregnancies of 262 women (85%) ended in term live birth and another 45 (15%) ended in miscarriage. Since crossing into Jordan, 11 women (4%) had not received reproductive health services. Of 35 women who were ≥ 35 years old, not pregnant, and did not want a (or another) child, nine (26%) did not use contraception. Of nine women who were ≥ 35 years old and pregnant, seven (78%) did not plan the pregnancy. The adjusted odds of miscarriage were higher in women who had been diagnosed with thyroid disease (aOR, 5.54; 95% CI, 1.56-19.07), had been of advanced maternal age (aOR, 5.83; 95% CI, 2.02-16.91), and had not received prenatal care (aOR, 36.33; 95% CI, 12.04-129.71). Each additional previous miscarriage predicted an increase in the adjusted odds of miscarriage by a factor of 1.94 (1.22-3.09)., Conclusions: We identified several risk factors for miscarriage in Syrian refugee women living in non-camp settings in Jordan. The risk factors may be amenable to preconception and prenatal care., (© 2022. The Author(s).)

Background: The mental health of refugee women is often affected by multiple risk factors in their social ecology. Assessing these risk factors is foundational in determining potential areas for intervention. We used the social ecological model to examine risk factors associated with self-reported mental health symptoms among clinic-attending Syrian refugee women in Jordan. We hypothesize that individual (older age, unmarried, have more children under 18, difficulty reading/writing with ease), interpersonal (intimate partner violence [IPV]), community and societal level risk factors (greater number of postmigration stressors), will be associated with depression, anxiety, and post-traumatic stress disorder (PTSD) symptoms., Methods: We surveyed 507 women using a cross-sectional clinic-based systematic sampling approach between April and November 2018. We used multivariable regressions to examine associations between different risk factors in the social ecology on depression, anxiety, and PTSD. Additional multivariable regressions explored associations between specific postmigration stressors and mental health conditions., Results: We found rates of depression among our sample to be 62.92%; anxiety 57.46%; and PTSD 66.21%. Our hypothesis was partially supported. At the individual level, age was directly associated with anxiety (aOR 1.04, 95% CI [1.02, 1.06]) and PTSD (aOR 1.03, 95% CI [1.01, 1.06]), while marriage decreased odds for depression (aOR 0.41, 95% CI [0.19, 0.92]) and PTSD (aOR 0.36, 95% CI [0.15, 0.87]). IPV was associated with depression (aOR 2.78, 95% CI [1.72, 4.47]); anxiety (aOR 3.30, 95% CI [2.06, 5.27]); and PTSD (aOR 5.49, 95% CI [3.09, 9.76]). Each additional community and societal risk factor (postmigration stressor) increased the odds for depression (aOR 1.32, 95% CI [1.22, 1.42]), anxiety (aOR 1.28, 95% CI [1.19, 1.39]), and PTSD (aOR 1.46, 95% CI [1.33, 1.60])., Conclusion: Understanding social ecological risk factors associated with mental health conditions of Syrian refugee women is vital to addressing their mental health needs. IPV and postmigration stressors are consistently impactful with all mental health conditions. IPV resulted in the largest odds increase for all mental health conditions. Multilevel interventions are needed to address mental health risk factors at multiple levels of the social ecology., (© 2022. The Author(s).)

Objectives: Health technology assessment (HTA) can increase the appropriateness and transparency of pricing and reimbursement decisions. Jordan is still in the early phase of its HTA implementation, although the country has very limited public resources for the coverage of healthcare technologies. The study objective was to explore and validate priorities in the HTA road map for Jordan and propose to facilitate the preferred HTA status., Methods: Health policy experts from the public and private sectors were asked to participate in a survey to explore the current and future status of HTA implementation in Jordan. Semistructured interviews with senior policy makers supported by literature review were conducted to validate survey results and make recommendations for specific actions., Results: Survey and interview results indicated a need for increased HTA training, including both short courses and academic programs and gradually increasing public funding for technology assessment and appraisal. Multiple HTA bodies with central coordination can be the most feasible format of HTA institutionalization. The weight of cost-effectiveness criterion based on local data with published reports and explicit decision thresholds should be increased in policy decisions of pharmaceutical and nonpharmaceutical technologies., Conclusion: Currently, HTA has limited impact on health policy decisions in Jordan, and when it is used to support pharmaceutical reimbursement decisions, it is mainly based on results from other countries without considering transferability of international evidence. Policy makers should facilitate HTA institutionalization and use in policy decisions by increasing the weight of local evidence in HTA recommendations., (Copyright © 2021. Published by Elsevier Inc.)

Implantation of venovenous extracorporeal membrane oxygenation as an alternative to invasive mechanical ventilation, an "awake approach," may facilitate a lung- and diaphragm-protective ventilatory strategies without the associated harms of endotracheal intubation, positive pressure ventilation, and continuous sedation. This report presents the characteristics and outcomes of the patients treated with the awake venovenous extracorporeal membrane oxygenation approach., Design: Retrospective case series., Setting: Monocenter study., Patients: Severe acute respiratory syndrome coronavirus 2 patients with acute respiratory failure treated with venovenous extracorporeal membrane oxygenation instead of invasive mechanical ventilation from March 2020 to March 2021., Interventions: None., Measurements and Main Results: Physiologic and laboratory data were collected at admission to the ICU, prior to and after venovenous extracorporeal membrane oxygenation implantation, and at decannulation. Seven patients were treated with venovenous extracorporeal membrane oxygenation instead of invasive mechanical ventilation due to hypoxemia with a median Pao 2 /Fio 2 ratio at implantation of 76 (interquartile range, 59-92). Four patients in the awake group subsequently required invasive mechanical ventilation, and only one patient (14.3%) died. There were no significant complications attributed venovenous extracorporeal membrane oxygenation., Conclusions: This report demonstrates that in a selected group of patients, an "awake" venovenous extracorporeal membrane oxygenation approach is feasible and may result in favorable outcomes., Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)

Background: COVID-19 has an inevitable burden on public health, potentially widening the gender gap in healthcare and the economy. We aimed to assess gender-based desparities during COVID-19 in Jordan in terms of health indices, mental well-being and economic burden., Methods: A nationally representative sample of 1300 participants ≥18 years living in Jordan were selected using stratified random sampling. Data were collected via telephone interviews in this cross-sectional study. Chi-square was used to test age and gender differences according to demographics, economic burden, and health indices (access to healthcare, health insurance, antenatal and reproductive services). A multivariable logistic regression analysis was used to estimate the beta-coefficient (β) and 95% confidence interval (CI) of factors correlated with mental well-being, assessed by patients' health questionnaire 4 (PHQ-4)., Results: 656 (50.5%) men and 644 (49.5%) women completed the interview. Three-fourths of the participants had health insurance during the COVID-19 crisis. There was no significant difference in healthcare coverage or access between women and men (p > 0.05). Half of pregnant women were unable to access antenatal care. Gender was a significant predictor of higher PHQ-4 scores (women vs. men: β: 0.88, 95% CI: 0.54-1.22). Among women, age ≥ 60 years and being married were associated with significantly lower PHQ-4 scores. Only 0.38% of the overall participants lost their jobs; however, 8.3% reported a reduced payment. More women (13.89%) were not paid during the crisis as compared with men (6.92%) (P = 0.01)., Conclusions: Our results showed no gender differences in healthcare coverage or access during the COVID-19 crisis generally. Women in Jordan are experiencing worse outcomes in terms of mental well-being and economic burden. Policymakers should give priority to women's mental health and antenatal and reproductive services. Financial security should be addressed in all Jordanian COVID-19 national plans because the crisis appears widening the gender gap in the economy.

Background: Breast cancer is the most common cancer afflicting women in Jordan. This study aimed to assess the effects of an educational intervention through home visits, including offering free mammography screening vouchers, on changing women's breast health knowledge and screening practices for early detection of breast cancer in a less privileged area in Jordan., Methods: Two thousand four hundred breast health awareness home visits were conducted and 2363 women aged 20-79 years (median: 41) answered a pre-test interview-administrated questionnaire to assess their breast health knowledge and practices at the baseline. After a home-based educational session, 625 women aged 40 years or older were referred to free mammography screening. Five hundred and ninety six homes were revisited six months later and out of these 593 women participated in a post-test. The women's retained breast health knowledge, the changes in their reported breast health practices and their usage of the free mammography voucher, were assessed., Results: The mean knowledge score increased significantly (p < 0.001) from 11.4 in the pre-test to 15.7 in the post-test (maximum score: 16). At the six month follow-up the post-test showed significant (p < 0.001) improvement in women's perceived breast self-examination (BSE) knowledge, reported BSE practice and mammography screening. Out of 625 women that received a voucher for free mammography screening 73% attended the mammography unit, while only two women without a voucher went for mammography screening at the assigned unit. Women who received a follow-up visit were more likely to use the free mammography voucher compared to those who were not followed-up (83% vs. 67%; p < 0.001)., Conclusions: Home visits by local community outreach workers that incorporated education about breast cancer and breast health in addition to offering free mammography screening vouchers were effective in improving women's breast health knowledge and practices in a less privileged area in Jordan.

Background: Breast cancer is the most common malignancy afflicting women, and the most common cancer overall in Jordan. A woman's decision to go for screening is influenced by her social support network. This study aims to explore Jordanian men's individual and contextual perspectives on women's breast cancer and their own role in the breast health of the females within their families., Methods: An explorative qualitative design was used to purposively recruit 24 married men aged 27 to 65 years (median 43 years) from four governorates in Jordan. Data in the form of interviews transcriptions was subjected to qualitative content analysis., Results: Three themes were identified: a) Supporting one's wife; b) Marital needs and obligations; c) Constrained by a culture of destiny and shame. The first theme was built on men's feelings of responsibility for the family's health and well-being, their experiences of encouraging their wives to seek health care and their providing counselling and instrumental support. The second theme emerged from men's views about other men's rejection of a wife inflicted by breast cancer, their own perceptions of diminished femininity due to mastectomy and their own concerns about protecting the family from the hereditary risk of breast cancer. The third theme was seen in men's perception of breast cancer as an inevitable act of God that is far away from one's own family, in associating breast cancer with improper behaviour and in their readiness to face the culture of Eib (shame)., Conclusions: Jordanian men perceive themselves as having a vital role in supporting, guiding and encouraging their wives to follow breast cancer early detection recommendations. Breast health awareness campaigns could involve husbands to capitalize on family support.

Background: Breast cancer is the leading cause of cancer mortality among Jordanian women. Breast malignancies are detected at late stages as a result of deferred breast health-seeking behaviour. The aim of this study was to explore Jordanian women's views and perceptions about breast cancer and breast health., Methods: We performed an explorative qualitative study with purposive sampling. Ten focus groups were conducted consisting of 64 women (aged 20 to 65 years) with no previous history and no symptoms of breast cancer from four governorates in Jordan. The transcribed data was analysed using latent content analysis., Results: Three themes were constructed from the group discussions: a) Ambivalence in prioritizing own health; b) Feeling fear of breast cancer; and c) Feeling safe from breast cancer. The first theme was seen in women's prioritizing children and family needs and in their experiencing family and social support towards seeking breast health care. The second theme was building on women's perception of breast cancer as an incurable disease associated with suffering and death, their fear of the risk of diminished femininity, husband's rejection and social stigmatization, adding to their apprehensions about breast health examinations. The third theme emerged from the women's perceiving themselves as not being in the risk zone for breast cancer and in their accepting breast cancer as a test from God. In contrast, women also experienced comfort in acquiring breast health knowledge that soothed their fears and motivated them to seek early detection examinations., Conclusions: Women's ambivalence in prioritizing their own health and feelings of fear and safety could be better addressed by designing breast health interventions that emphasize the good prognosis for breast cancer when detected early, involve breast cancer survivors in breast health awareness campaigns and catalyse family support to encourage women to seek breast health care.

Objective: To estimate the number of maternal deaths per 100000 live births during 2007-2008 among Jordanian women; to identify the causes of maternal mortality; and to compare the results with those of the last report for 1995-1996., Methods: Reproductive-age mortality study of maternal deaths among women aged 15-49 years in Jordan in 2007-2008., Results: Among 1406 identified deaths of reproductive-aged women, 76 maternal deaths were identified out of 397588 live births, for a maternal mortality ratio of 19.1 deaths per 100000 live births. Forty-three (56.6%) deaths were attributable to hemorrhage, thrombosis and thromboembolism, and sepsis. Avoidable factors were present in 53.9% of women, 52.6% had substandard care, and 31.5% had 3 or fewer antenatal visits. Of those with available information on family planning, only 29.4% had ever used any form of contraception., Conclusions: Maternal deaths in Jordan are declining. The maternal mortality ratio of 19.1 deaths per 100000 live births reported for 2007-2008 showed a remarkable reduction of 53.9% achieved in the 12 years since the 1995-1996 report (a 4.5% annual reduction), which is approaching the 75% reduction recommended by Millennium Development Goal 5., (Copyright © 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.)

Background: Breast cancer is the most common cancer among women in Jordan and on average 70% of the cases present at advanced stages. The aim of this study was to assess the effectiveness of a public educational campaign conducted by the Jordan Breast Cancer Program to improve breast health knowledge among Jordanian women and to relate their knowledge to breast health practices., Methods: The campaign was conducted in five governorates in Jordan with a total of 105 public group lectures about breast cancer focusing on early detection. The total number of participants was 2,554 women with a median age of 37 years (range: 15-73 years). Median number of women per lecture was 24 (range: 9-38). Before the lectures, the women answered a structured questionnaire about their knowledge and practices. After the intervention 2,418 of them filled a post-test questionnaire with the same content. Correct answers on the 15 knowledge questions yielded a maximum score of 15. Determinants of breast health practices were identified using multivariable logistic regression analysis., Results: The mean knowledge score increased significantly from 10.9 in the pre-test to 13.5 in the post-test (p<0.001). The percentage with a minimum of 14 correct answers to the 15 questions increased from 18 to 63% (p<0.001). Adequate breast health practices were generally low but increased significantly with increasing age and attendance at a previous lecture on breast cancer. Breast health practices were also higher among married women and housewives, and significantly associated with older age and greater breast health knowledge (p<0.001)., Conclusions: Group educational lectures appeared effective for improving breast health knowledge among Jordanian women. However, even with the noticeable level of knowledge at the baseline, there were low breast health practices among the study participants. This necessitates further in-depth research to explore womens experiences and socio-cultural barriers to breast health seeking behaviour in Jordan.

Enhancing the quality of reproductive health care delivery in developing countries is a key prerequisite to increased utilization and sustainability of these services in the target population. Our objective was to assess the perception of quality of reproductive health (RH) care services provided by Jordanian Ministry of Health community-based centers from the perspective of service providers in these settings. A purposeful nationwide sample of 50 primary health care providers took part in five focus group discussions with the purpose of exploring their perceptions of the quality of care provided by their centers and perceived barriers to the provision of quality RH care. Health care providers felt that the quality of RH care provided by their centers was suboptimal. Focus group participants reported numerous barriers to the provision of high quality-care in the clinical setting. These included issues related to patient overload, patient and physician characteristics, as well as problems inherent to supervisory and administrative functions. Exploring and aligning goals and expectations of RH care providers and administrators may result in improvements in the quality of RH care service delivery and morale in public health settings in Jordan, which is a requirement for public sector reform.

In this article we seek to determine the effect of the knowledge of prenatal fetal sex, through the use of ultrasound, on infant mean birth weight and the proportion of low birth weight (LBW) babies. A sample population of 1,195 women (cases, n = 640; control, n = 555) were studied in relation to their knowledge of the sex of the fetus in three hospitals in Amman, Jordan. It was found that prenatally known males had the highest mean birth weights (MBWs) as compared with females. It is proposed that these differences could be attributed to behavioral factors related to son preference. The authors conclude that further research on the actual link between prenatal detection of fetal sex and health behavior as indicated by birth weight is needed.

Our objective in this study was to determine the prevalence of reproductive and related nonreproductive morbidities in a group of reproductive-aged women living in Jordan. The study was designed as a two-phase survey. The first phase consisted of a structured personal interview and the second phase was a follow-up physical examination. Three hundred seventeen women aged 18-49 years were randomly selected and answered the questionnaire in the first phase of the study. Two hundred sixty agreed to both the general physical and pelvic examination. The main outcome measures were selected reproductive and related nonreproductive morbidities. Results show reproductive tract infections were diagnosed in 55% of the women, a presumed chlamydia trachomatis genital infection in 40%, and genital prolapse in 22%. As for related nonreproductive morbidities, 14% were diagnosed with a urinary tract infection (UTI), 24% with urinary incontinence, and 40% with anemia. Our results of the study support the idea that in this community, women's health is at risk throughout their reproductive years, not only when they are pregnant or postpartum. We suggest further research in other Jordanian communities as well as solutions addressed to the health care community.

Objective: This study aims to increase the body of knowledge regarding osteoporosis in the Jordanian context by investigating the magnitude of osteoporosis amongst perimenopausal women, as well as the risk factors associated with the disease., Methods: Two hundred and fifty one women between the ages of 40 to 60 years were randomly selected from the Orthopedics and Rheumatology out patient clinics at the Major Teaching Hospital in Amman, Jordan. A structured questionnaire, which focused upon risk factors and preventive measures for osteoporosis, was administered by a trained staff nurse to all women. Index women were then referred to a private hospital, also in Amman, for a dual energy x-ray absorptiometry of the lumbar spine (Lumbar 1-4) and hip., Results: Results show the magnitude of osteoporosis was 13% according to the bone mineral density of the lumbar spine. Women with osteoporosis were older (p< 0.00) and smaller in build (p<0.00) than women with low or normal bone density. Osteoporotic women were also more likely to be menopausal (p<0.00) and to have taken corticosteroids for a prolonged period of time (p<0.00). Logistic regression showed being menopausal (p<0.00), taking corticosteroids (p<0.05), and having a relatively lower body mass index (p<0.00) were significantly related to being osteoporotic in this group of women., Conclusion: The authors conclude that this study was not only able to report upon the magnitude of osteoporosis among women sampled, and the risk factors for low bone density, but also raised issues related to inconsistencies in how the health care system deals with women who are at risk for osteoporosis. Study findings are discussed in their socio-cultural context, and implications of the study findings are presented.

Objective: This study attempts to identify factors contributing to patients' satisfaction and to examine the relationship between patient satisfaction and patient expectations., Methods: The study sample consisted of 360 patients randomly drawn from the outpatients' practice of 2 health centers in Irbid, North Jordan; a university and governmental one. Patients' satisfaction was assessed using a self-administered patient satisfaction questionnaire. Patients' expectations were assessed by exposing patients to a series of video clips showing pre-tested patient provider encounters., Results: On average, users of the Community Health Center had lower expectation levels and higher satisfaction means when compared to users of the University Health Center. The study results showed that patient satisfaction was mainly influenced by patient expectation of received care even after adjustment for socio-demographic variables., Conclusion: This study therefore, argues that while assessment of patient satisfaction is useful as a monitoring indicator for overall health care delivery performance, still interventions are required to improve the delivered care. There is a need to examine client expectations and tailor services accordingly since satisfaction measures can only diagnose a problem while expectation assessment can identify clients needs and thus program managers can better design health services delivery.

Rationale: To begin to fill the information gap on the health of menopausal women in developing countries., Objectives: Objectives were three fold: to establish an approximate age of onset of menopause for women in the study area; to report on the physical presence of certain physical conditions; and, to record the self-reported frequency of signs/symptoms of menopause in the 6 months prior to the study., Methodological Design: A descriptive study of women randomly sampled from the study community., Research Methods: Women's homes were randomly sampled from the residential blocks surrounding the local community health centre. Women agreeing to the first phase of the study were also asked to consent to the second phase, then revisited to complete this second phase., Instruments: The first phase of the study involved an in-depth semistructured questionnaire and the second phase, a general and pelvic examination with laboratory tests., Outcome Measures: To gather the information as set out under Objectives., Results: One hundred and thirty seven women were included in the study. The median age of menopause was 49 years. Women either reported or were found to be suffering from a variety of health problems including: urinary incontinence (37%), urinary tract infections (UTI) (11%), reproductive tract infections (RTI) (39%), and genital prolapse (41%)., Conclusions: Menopausal women suffer from an appreciable level of morbidity as they approach menopause. Also, the level of health awareness of these women lags behind the identified prevalence of the studied conditions.

This study examined the growth patterns of Jordanian children below three years of age in comparison with the NCHS reference population. Weight and length measurements of 1224 boys, and 1120 girls were obtained from a national multipurpose study of Jordanian preschool children carried out in 1984. The study results showed that children of both sexes grew at Gentiles that were close and parallel to the NCHS in the first quarter of the first year. However, both weight and length Gentiles departed from the NCHS counterparts later on with length showing marked differences from the reference. The differences observed between the local and the NCHS reference population suggest that the NCHS should be used as a target for planning and evaluation of' intervention programs at a national level while the need for the local standards to assess individual cases remains a necessity.

The quality of information provided to pregnant women seeking prenatal care from public maternal and child health (MCH) facilities was assessed in Irbid, the principal city in the North of Jordan. The structural setup of the settings, as well as the process of information transmission, were examined using interviews of the managing physicians and recipients, as well as observation of encounters between pregnant women and health care providers (physicians and midwives) at the health facility. The results of the study showed that pregnant women's needs for health information were not being adequately met Women were dissatisfied with the quality of information delivered. Inadequacies in both the structure and the process of information provision are discussed.

The prevalence of nasopharyngeal Streptococcus pyogenes in children attending day care centers in North Jordan was studied. Nasal and throat swabs, cultured for Streptococcus pyogenes were collected from 100 children enrolled in four day care centers serving middle to high socioeconomic status portions of the population in March 1989. The identity of the streptococcal isolates was confirmed by biochemical and serological methods. Throat infection manifestations of the past 3 days, as reported and observed by the care givers, were related to culture results. The study findings showed that the prevalence of nasopharyngeal Streptococcus pyogenes was high and ranged between 10 to 23.3%. It was also noted that the care givers were able to correctly identify children with suspected throat infection, in 11 to 25% of the children who grew Streptococcus pyogenes on cultures, by mere observation of the symptoms. Due to the high prevalence of nasopharyngeal Streptococcus pyogenes in these settings, measures to control and prevent the spread of Streptococcus pyogenes must be employed. This study suggests that care givers may play an important role in achieving such a goal if they are offered proper health education programs and instructions on child hygiene.