High rate of hypertension control among treated patients attending a teaching primary healthcare centre in Jordan.

INTRODUCTION: The purpose of this study was to determine the hypertension control rate and its associated factors among treated patients attending a teaching primary healthcare centre in Jordan. STUDY DESIGN: We conducted a retrospective cohort study of 286 patients with HTN, treated with medications, who attended Jordan University of Science and Technology primary healthcare centre in Irbid, Jordan, from July through September 2018. Data were abstracted from the patient's medical records and personal interviews. Multivariate logistic regression analysis was used to examine independent factors associated with hypertension control. RESULTS: Blood pressure control rate was 90.9% and was significantly higher among patients who were married (p=0.02), with higher income level (p<0.01), non-smokers (p=0.01), free of diabetes mellitus or dyslipidaemia (p=0.048), highly consuming fruits and vegetables (p<0.01), non-obese (p<0.01), adherent to blood pressure medications (p=0.02) and among patients on lower number of antihypertensive medications (p=0.01). Multivariate analysis with adjusted OR of factors associated with hypertension control were higher fruit and vegetable intake (p<0.01), higher income level (p=0.02) and medication adherence (p<0.01). CONCLUSION: Participants in this study achieved a relatively high rate of blood pressure control. Associated factors with this rate were higher fruit and vegetable intake, higher income level and medication adherence. For better hypertension control, patients should be advised to adhere to their medications and consume more fruits and vegetables besides other lifestyle changes.

Knowledge, attitude, and behaviors of health professionals towards smoking cessation in primary healthcare settings.

This study aimed to assess the behaviors of multiple health professionals in primary healthcare settings in Jordan towards smoking cessation counseling and to determine the barriers to effective smoking cessation behaviors. A survey of 456 health professionals in primary healthcare settings was conducted. A self-administrated questionnaire was used to collect the data. About half of health professionals reported that they usually ask patients about smoking status and advise them to stop smoking (51.4% and 50.5%, respectively). Only 23.7% reported assessing the willingness of the patients to quit smoking and 17.9% reported discussing counseling options with smokers. Considerably fewer percentages of health professionals reported preparing their patients for withdrawal symptoms (6.0%), discussing pharmacotherapies (3.8%), and prescribing nicotine patches (6.4%). Key barriers to smoking cessation counseling, as reported by health professionals, included: insufficient resources and organizational support, limited coverage of cessation interventions, and lack of motivation to quit. Smoking cessation counseling was not routinely implemented by Jordanian health professionals. Barriers to effective delivery of smoking cessation counseling need to be integrated within relevant strategies aiming at enhancing the frequency and quality of health professionals' engagement in smoking cessation.

Vildagliptin efficacy in combination with metformin among Jordanian patients with type 2 diabetes mellitus inadequately controlled with metformin.

Objective: To assess the efficacy and safety of vildagliptin added to metformin in patients with type 2 diabetes mellitus (T2DM) inadequately controlled with metformin monotherapy. Methods: This was a 12-week prospective observational study where vildagliptin 50 mg twice daily was added to patients with T2DM inadequately controlled (glycosylated hemoglobin type A1c (Hba1c) 7-10%) by a daily dose of metformin ≥1700 mg between June 2012 and May 2013. Efficacy was assessed by change in Hba1c and fasting plasma glucose (FPG) levels, and safety was assessed by reported adverse events (AEs). Results: A total of 58 patients were enrolled in this study. Their age ranged between 39.0 and 71.0 years, with a mean of 52.6 years, and a standard deviation (SD) of 7.8. The average duration of diabetes mellitus (DM) was 4.0 years (SD 3.0) and half of the patients have had DM for more than three years. The mean baseline levels of Hba1c and FPG were 8% and 10.8 mmol/L, respectively. Patients treated with vildagliptin achieved clinically significant reductions in Hba1c of 1.1% (p value <.005) and reduction in FPG of 1.8 mmol/L (p value <.005) from baseline. Overall, 62.1% had achieved the target of Hba1c of <7% after vildagliptin use. Greater reductions in Hba1c were linked to higher baseline levels as well as to the daily frequency of metformin use. Mild AEs were reported by 16 patients. There was no incidence of hypoglycemia and there were no significant changes in body weight after treatment. Conclusions: Vildagliptin as add-on therapy to metformin improved glycemic control and was highly tolerable in T2DM patients who were inadequately controlled by metformin monotherapy.

Prevalence of chronic obstructive pulmonary disease among adult male cigarettes smokers: a community-based study in Jordan.

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. The prevalence of COPD among cigarette smokers in the Middle East is not well studied. A prospective descriptive study was performed in the north of Jordan. Male cigarette smokers (≥ 10 pack-year) aged 35 years and older were recruited from the community. They completed a questionnaire and a postbronchodilator spirometry. Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria (postbronchodilator forced expiratory volume in 1 second <70%) was used to define COPD. A total of 512 subjects completed the study protocol. According to the GOLD criteria, 42 subjects (8.2%) had COPD. Of those, 27 subjects (64.3%) had symptomatic COPD. Using the GOLD criteria, eight subjects (19%) with COPD had mild disease, 24 (57.1%) had moderate disease, eight (19%) had severe disease, and two (4.8%) had very severe disease. Only 10.6% were aware of COPD as a smoking-related respiratory illness, and 6.4% had received counseling about risk for COPD by a physician. Chronic bronchitis (cough for 3 months in 2 consecutive years) was reported by 15% of the subjects, wheezes by 44.1%, and dyspnea by 65.2%. Subjects with COPD reported having more chronic bronchitis 18/42 (42.9%) and wheezing 28/42 (66.7%) than subjects without COPD. The prevalence of COPD increased with increased number of pack-years smoked. In conclusion, COPD prevalence among cigarette-smoking men in Jordan is lower than in the developed world. COPD was largely underdiagnosed, despite the majority of participants being symptomatic and having moderate to severe disease.

Knowledge, attitudes and current practice of Jordanian family physicians about prescribing aspirin in primary and secondary prevention of vascular diseases: a self-reported survey.

BACKGROUND: Long-term aspirin therapy is crucial for patients with increased risk of occlusive vascular diseases. However, inconsistencies in the methods for risk assessment and the perception among health care providers are major contributing factors for challenges in risk assessment. METHODS: A questionnaire was distributed to a total of 124 family physicians working at two university teaching centers and Ministry of Health primary health care centers in Jordan. RESULTS: A majority of the physicians reported prescribing aspirin for patients if they have peripheral vascular disease (93%), post-coronary artery bypass graft (92%), stroke (90%), or stable angina (95%). A smaller percentage of physicians reported that they prescribe aspirin if patients have atrial fibrillation (81%) or acute myocardial infarction (85%). The percentage of physicians who prescribe aspirin markedly declined when patients have potential bleeding disorder (52%) or asthma (52%). For patients without cardiovascular diseases but with one or more risk factors, the prophylactic use of aspirin was reported by 85% to 95% of family physicians. CONCLUSIONS: The presence of co-morbidity along with vascular diseases tended to hinder physicians from prescribing aspirin even when it is indicated. A majority of family physicians recommends the use of aspirin in primary prevention in spite of its questionable or even negative benefits. Furthermore, self-reported aspirin prescribing rates among physicians in Jordan are higher than those reported by physicians in the U.S. and Europe. Therefore, we believe that proper dissemination of updated evidence-based treatment guidelines is required to ensure appropriate and efficient preventive services for cardiovascular diseases.

The effect of evidence-based medicine (EBM) training seminars on the knowledge and attitudes of medical students towards EBM.

BACKGROUND: There is debate about the most effective method for teaching evidence-based medicine (EBM) in medical schools. This study was conducted to evaluate the effect of integration of EBM training seminars into the curriculum of the community medicine course in changing the knowledge and attitudes of the fourth year medical students towards EBM. METHODS: This is a quasi-experimental study conducted on the fourth year medical students who joined the community medicine mandatory summer course at Jordan University of Science and Technology in the period between July 1 and August 31, 2008. We measured medical students' self-reported attitudes about and knowledge of EBM before the integration of EBM seminars into the community medicine course and at the end of course. RESULTS: A high proportion of students had positive attitude towards EBM before and after the course. After the course, the vast majority (91.8%) became aware of the presence of guidelines and protocols for diseases compared with 59.0% who were aware of that before (P < 0.005). Only small proportion of students reported that they understand and able to explain the common epidemiological concepts that are used in EBM before the training. After the training, a significantly higher proportion of students reported understanding the epidemiological concepts. CONCLUSION: Integration of EBM training course into community course for the fourth year students improved their EBM knowledge. Longitudinal studies are needed to evaluate the long-term effects of EBM curriculum in changing behaviours, practice patterns and patient care outcome.

Prevalence of dyslipidemia and its associated factors among Jordanian adults.

BACKGROUND: Dyslipidemia, which has been closely linked to pathophysiology of cardiovascular diseases, is a key independent modifiable risk factor for cardiovascular diseases. Estimation of the prevalence of dyslipidemia ensures proper planning of health actions for both primary and secondary prevention of cardiovascular diseases. OBJECTIVES: To estimate the prevalence of various types of dyslipidemia and determine their associated factors among adults in north of Jordan. METHOD: Data were analyzed from a cross-sectional study that included a random sample of 1121 Jordanians aged 25 years and older. High total cholesterol (TC) was defined as TC ≥200 mg/dL and hypertriglyceridemia as serum triglycerides level ≥150 mg/dL. Low high-density lipoprotein cholesterol (HDL-C) was defined as serum HDL-C <40 mg/dL. High low-density lipoprotein cholesterol (LDL-C) was defined as serum LDL-C ≥130 mg/dL. RESULTS: Of a total of 1121 subjects, 48.8% had high TC level, 40.7% had high LDL-C, 40.1% had low HDL-C, 43.6% had high triglyceride levels, and 75.7% had at least one abnormal lipid level. Age was associated with high triglycerides, high LDL-C, and high TC. Men were more likely than women to have a high triglycerides level and low HDL-C. Compared with people with a body mass index <25, overweight and obese subjects had greater odds of having high triglycerides, high TC, and low HDL-C. Diabetes was associated with increased odds of high triglycerides only. CONCLUSION: The prevalence dyslipidemia is high in Jordan, which necessitates appropriate the institution of community-based intervention strategies to prevent and manage cardiovascular risk factors.

Consanguinity and adverse pregnancy outcomes: the north of Jordan experience.

This cross-sectional study was carried out to assess the association between consanguineous marriages and adverse pregnancy outcome in the north of Jordan. Women delivered in four major hospitals in the north of Jordan between April 2007 and May 2007 were included in the study. Non-Jordanian women and women with multiple pregnancies were excluded. Mothers answered a pilot-tested structured questionnaire administered by trained personnel in the maternity ward. Data regarding pregnancy outcomes were obtained from the patients' individual records. A total of 3,269 women with a mean age of 27.2 (SD 6.6) years were included. About 49% of women had consanguineous marriages. Consanguineous marriages were significantly associated with low birth weight delivery (13.9% vs. 10.1%), preterm delivery (19.9% vs. 12.3%), and births with congenital anomalies (4.1% vs. 0.8%) compared with non-consanguineous marriages. In the multivariate analysis, consanguinity was significantly associated with preterm delivery (OR = 1.5, 95% CI 1.2, 1.9), and congenital malformations (OR = 6.5, 95% CI 2.8, 15.3). In conclusions, this study supports the association between consanguinity and some adverse pregnancy outcomes.

Glycaemic control among patients with type 2 diabetes mellitus treated in primary care setting in Jordan.

AIMS: Determine the rate of glycaemic control among patients with type 2 diabetes treated in a university teaching family health centre and determine factors associated with glycaemic control. METHODS: A family physician reviewed medical records of all type 2 diabetic patients aged 18 years or older, who attended the university medical centre of Jordan University of Science and Technology between September 2007 and December 2008. All relevant information were abstracted from medical records and filled in a special form. RESULTS: Of the total 337 patients, 56.1% had HbA1c<7%. The mean HbA1c was 7.1%. About half (46.6%) achieved target blood pressure <130/80. Furthermore, half of the patients achieved the target levels of total cholesterol, triglycerides and HDL. However, only 10.4% achieved the target level of LDL. In multivariate analysis only increased duration of disease (>5 years vs. < or =5 years) and type of treatment (insulin alone or combination therapy vs. oral therapy only) were significantly associated with increased odds of HbA1C>7%. CONCLUSIONS: More than half (56.1%) of diabetic patients had HbA1c values of less than 7%. Such finding highlight the importance of providing an organised care in managing diabetic patients in primary care setting and can be a base for further longitudinal studies to evaluate such care.

Awareness, attitude and practice of evidence-based medicine among primary health care doctors in Jordan.

OBJECTIVES: To assess the awareness, attitude and knowledge towards evidence-based medicine (EBM) among primary health care doctors in Jordan and to identify the perceived barriers for practising EBM. METHODS: A simple random sample of 34 comprehensive primary health care centres was selected from a list of 64 centres in Jordan using random number table. A family doctor visited all selected centres and invited the available doctors to participate in the study. Participants were asked to fill the self-administrated questionnaire that was designed to assess beliefs and attitude of doctors towards EBM. RESULTS: Of the total 220 clinicians approached, 202 (91.8%) completed the questionnaire. About 80.7% welcomed promotion of EBM and 91.1% agreed on that research findings are helpful in daily management of patients. About 85.1% stated that practising EBM improves patient care, 68.3% stated that EBM reduces health care costs, 74.8% stated that EBM improves quick knowledge update, 93.6% reported that the doctor-patient relationship is affected positively by practising EBM. About 60.9% reported that they know the concept of EBM and 56.1% reported that they ever used the EBM. Patient overload, limited resources and facilities, and the absence of an effective computer system were the most commonly reported barriers to the implementation of EBM. CONCLUSIONS: In spite of the positive attitude towards EBM, this study demonstrated numerous personal, interpersonal and institutional barriers towards implementing EBM which necessitate prompt action to formulate a national plan to overcome such barriers.

Evidence-based medicine among hospital doctors in Jordan: awareness, attitude and practice.

OBJECTIVES: The aim of this cross-sectional study was to determine the awareness and attitude of hospital doctors towards evidence-based medicine (EBM) and their related educational needs. METHODS: A questionnaire study was performed on a randomly selected sample of 386 hospital doctors from both a teaching hospital and the Ministry of Health general hospitals in Jordan. Attitude towards EBM, best method of moving from opinion-based medicine to EBM, accessing and interpreting evidence and perceived barriers to practise EBM among participants were the main outcome measures. RESULTS: Participants welcomed promotion of EBM and 91.2% agreed that research findings are helpful in daily management of patients. About one-third of respondents (32.7%) thought that the most appropriate way to move towards EBM was by seeking and applying EBM summaries. About one half of participants (47.9%) were unaware of Cochrane database and only 5% used it to help in clinical decision making. More than half (53.7%) reported that they had access to the Internet at their office. Only minority understand the technical terms used in EBM. The major barriers to practising EBM were threat to clinical freedom/judgement, limited resources and facilities, patient overload absence of library in the locally and lack of personal time. CONCLUSIONS: Although there is a high support among doctors for the promotion of EBM, there is a deficit in knowledge and skills of EBM. Hence, the time appears ripe for planning and implementing an effective EBM educational programme for both undergraduate and postgraduate doctors.