Association between albumin and depression: a population-based study.

INTRODUCTION: Albumin is the most prevalent plasma protein and is involved in a variety of critical physiological processes. Low serum albumin levels have been linked to depression symptoms in people who had recent suicide attempts and those suffering from several mental diseases such as acute episodes of mania, and schizophrenia. However, there has been little investigation into the relationship between depression and serum albumin levels in community-dwelling persons. This research aimed to examine the relationship between serum albumin and depression in a population-based sample and whether it differs depending on other possible confounders. METHODS: Our data were derived from a national household population study conducted in 2017 with a sample size of 3,521 Jordanians aged > 17 years old. The Patient Health Questionnaire (PHQ-9) scale, a self-administered scale, was used to screen for depression. Concentrations of serum albumin and other medical biomarkers were measured by blood tests. Using descriptive statistics for depression distribution and multivariate logistic regression analysis, the connection between albumin levels and depression was investigated. RESULTS: The odds ratios (ORs) for depression were significantly lower in the third and fourth quartiles of serum albumin concentration compared to the first quartile (OR = 0.64 and 0.66, respectively; P values = <0.001 and <0.001, respectively). This association was statistically significant even after controlling for variables such as gender, age, marital status, education, and occupation (OR = 0.67 and 0.75, respectively, and P values = 0.001 and 0.02, respectively), as well as after further controlling for other health status variables such as nutrition, comorbidity, body mass index, somking status, and biomedical markers such as serum calcium, phosphate, and magnesium (OR = 0.58 and 0.59, respectively, and P values = <0.001 and 0.001, respectively). Moreover, the unadjusted and adjusted odds ratios in the three regression models declined linearly with rising quartiles of serum albumin (P trend = <0.001, 0.009, and 0.001, respectively). CONCLUSIONS: Our research found an inverse relationship between serum albumin and depression. Serum albumin could be a warning measure for depression. It is required for appropriate intervention measures to be implemented.

Quality of care for type 2 diabetes in Jordan: A national study.

The present study aimed to describe the quality of healthcare delivered to patients with type 2 diabetes in Jordan in 2017. Another objective was to identify the factors related to glycemic control and hospital admission due to type 2 diabetes. This was a national population-based household study. Aspects of care quality were evaluated in relation to outcomes, such as glycemic control [hemoglobin A1c; glycated hemoglobin (HbA1c) level <7%] and hospital admission owing to diabetes. A total of 754 patients previously diagnosed with type 2 diabetes and aged ≥25 years were recruited. The number of annual visits was >10 for 48.5% and 1-4 for 38.2% of patients. The proportion of patients achieving glycemic control was 33.0%. In total, 4 of 5 patients reported easy access to health facilities and good health team support. Foot and eye examinations were performed for 24.9 and 55.0% of the patients, respectively. Dietary advice was delivered to 87.5% of the patients. Glycemic control exhibited a significant inverse association with the duration of diabetes and the number of annual visits. Following a specific diet for managing diabetes and the cessation of medication after an improved well-being were independently associated with a higher likelihood of glycemic control (HbA1c <7%). On the whole, the present study demonstrates that a number of indicators for the quality of diabetes care in Jordan were relatively satisfactory; however, others require improvement. The findings demonstrate that numerous patients with diabetes in Jordan require education about the treatment and management of, and complications associated with diabetes, especially those who are recently diagnosed.

Osteoporosis among Postmenopausal Women in Jordan: A National Cross-Sectional Study.

Osteoporosis is considered a widespread health problem that affects senior citizens, particularly older women, after the menopause. This national study aimed to estimate the prevalence of osteoporosis among Jordanian postmenopausal women and to determine the association of demographic and nutritional factors, such as calcium and vitamin D supplement intake, with osteoporosis in postmenopausal women. A cross-sectional study was conducted among 884 postmenopausal women aged ≥50 years. A multistage sampling technique was used to select participants from three geographic regions of Jordan (north, middle, and south). The data were collected from the participants by a team of field researchers comprising men and women through a standard questionnaire. The prevalence of osteoporosis was 19.8% among postmenopausal Jordanian women. The study results showed that age (p ˂ 0.001), geographic region (p = 0.019), occupation (p = 0.002), and educational level (p = 0.001) were significantly associated with osteoporosis. Moreover, osteoporosis was significantly associated with calcium and vitamin D supplement intake (p < 0.05). There is a high prevalence of osteoporosis among postmenopausal Jordanian women. Therefore, there is a need to educate women at this age, and probably at an earlier age, to prevent or reduce the development of osteoporosis.

Trauma exposure and post-traumatic stress symptoms among Syrian refugee youth in Jordan: Social support and gender as moderators.

This study assessed relations between exposure to trauma and post-traumatic stress (PTS) symptoms, and whether perceived social support from family and friends and gender moderated these associations. Syrian refugee youth (N = 418, 55.0% female) attending public schools in Jordan participated. Boys reported more age-adjusted PTS symptoms than girls. Analyses revealed that family support and gender moderated the association of trauma on PTS symptoms. For males, the benefits of family support were most evident under conditions of high traumatic stress exposure, while for females, benefits of family support were evident when no loss or injury to family members had been reported. Support from friends was not helpful for either gender. School- or family-based interventions designed to treat PTS symptoms need to consider the different needs of boys and girls, particularly within the Syrian Muslim cultural context.

Metabolic syndrome amongst adults in Jordan: prevalence, trend, and its association with socio-demographic characteristics.

BACKGROUND: Multiple epidemiological studies were conducted amongst a variety of ethnic groups and showed discrepancies in the prevalence of metabolic syndrome (MeS) and its individual components. This study aimed to determine the prevalence of MeS in Jordan using both the Adult Treatment Panel Guidelines (ATP III) and the International Diabetes Federation (IDF) criteria. The study also aimed to assess the changes in the prevalence of MeS over time and determine its association with sociodemographic variables. METHODS: Data from the 2017 Cardiovascular Disease Risk Factors Survey were used for this study. Socio-demographic and clinical data were collected using a structured questionnaire. Blood samples were taken for biochemical measurements. Furthermore, anthropometric characteristics were measured by the same team of trained field researchers. A sample of 4,056 individuals aged between 18 and 90 years was included in this study. The findings from the 2017 survey were compared with the findings of a 2009 survey that adopted the same methods and procedures. RESULTS: According to the IDF criteria, the crude prevalence of Metabolic syndrome was 48.2% (52.9% among men and 46.2% among women; p < 0.001). Using the ATP III criteria, the prevalence was 44.1% (51.4% among men and 41% among women, p < 0.001). The age-standardized prevalence rate of metabolic syndrome was 44% (95% CI 42.7, 45.4) and 39.9% (95% CI 39.6, 41.2), according to both the IDF definition and ATP III criteria, respectively. The Kappa measure of agreement showed excellent agreement between the two definitions (k = 81.9%, p < 0.001). Of all participants, 41.7% met both the IDF and ATP III diagnostic criteria, 6.6% met the IDF criteria only, and 2.5% met the ATP III criteria only. The age-standardized prevalence rate of metabolic syndrome was significantly higher in 2017 (45.7% in men and 44.5% in women) than that in 2009 survey (34.6% in men and 39.8% in women). Gender, age, occupation, region, and marital status were significantly associated with metabolic syndrome. CONCLUSIONS: The prevalence of metabolic syndrome in Jordan is considerably high and it is increasing. Healthy lifestyle programs encouraging appropriate dietary habits and physical activity are strongly recommended in Jordan.

An alarmingly high and increasing prevalence of obesity in Jordan.

OBJECTIVES: The aim of this study was to determine the prevalence of obesity in Jordan, to assess related trends, and to determine associated factors and comorbidities. METHODS: A multipurpose national household survey of Jordanian adults was conducted over a 4-month period in 2017. Data were collected using a structured validated questionnaire. Anthropometric measurements including waist circumference (WC; measured midway between the iliac crest and the lower rib margin), body mass index (BMI), hip circumference, waist-to-hip ratio, and waist-to-height ratio were obtained to categorize participants with regard to overweight and obesity. RESULTS: This study included 4,056 persons (1,193 men and 2,863 women) aged 18 years to 90 years (mean±standard deviation, 43.8±14.2 years). According to the International Diabetes Federation WC criteria, the age-standardized prevalence of obesity was 60.4% among men and 75.6% among women, while approximately three-quarters of men and women were overweight or obese as defined by BMI. The age-adjusted odds of obesity in 2017 were approximately twice those in 2009 in men (odds ratio [OR], 1.98) and women (OR, 1.96). In the multivariate analysis, age, region of residence, and marital status were significantly associated with obesity in both genders. Obesity was significantly associated with increased odds of diabetes mellitus, hypertension, elevated triglycerides, and low high-density lipoprotein cholesterol after adjusting for age. CONCLUSIONS: The rate of obesity in Jordan is high and increasing, and obesity is associated with other metabolic abnormalities. Well-defined programs to control and prevent obesity, as well as intersectoral action, are urgently required to reverse current trends.

The Frequency and Risk Factors of Diabetic Foot Ulcer Recurrence Among Jordanian Patients with Diabetes.

BACKGROUND: Diabetic foot is a major public health problem and their complications are an imperative cause of morbidity and mortality in diabetes. OBJECTIVE: To evaluate the rate of recurrence of foot ulcers post two years of follow-up, including the associated risk factors in the patients attending the diabetic foot clinic at the National Center for Diabetes, Endocrinology, and Genetics (NCDEG), Amman, Jordan. METHODS: A historical cohort design was adopted for the patients who presented for the first time to the diabetic foot clinic at the NCDEG. Every patient who came to the clinic was reviewed by using his or her medical files with respect to diabetic foot-related complaints. Patients were classified under four categories: (1) Recurrent foot ulcers (2) chronic foot ulcer (3) free of recurrence, and (4) no foot ulcers. Among the four groups, group 1 (recurrent foot ulcers, n=76) and group 3 (free of recurrence, n=54) were included for the analysis. RESULTS: Among the 141 patients who presented to the diabetic foot clinic during the two-year study period, 76 (53.9%) of them experienced ulcer recurrences, 54 (38.3%) were recurrence-free, and 11 (7.8%) had chronic ulceration. The two-year recurrence rate was 58.5%. The presence of deformity and osteomyelitis were the statistically significant independent risk factors for recurrent foot ulceration. CONCLUSION: This study of recurrences was clearly related to the type and complications of the ulcers rather than to the other variables. Recurrent foot ulceration is linked to the presence of osteomyelitis and/or deformities.

The performance of anthropometric measures to predict diabetes mellitus and hypertension among adults in Jordan.

OBJECTIVES: This study aimed to evaluate and compare the abilities of waist circumference (WC), body mass index (BMI), hip circumference (HC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) to predict recently and previously diagnosed diabetes and hypertension and assess their appropriate cut-off values among Jordanian adults. METHODS: Data from the 2017 cardiovascular risk factors survey were analyzed to achieve the study objective. The survey collected extensive data from a national population-based sample of Jordanian residents. A structured questionnaire was used to collect sociodemographic variables and clinical data. Blood samples were taken for biochemical measurements. Anthropometric characteristics were measured by the same team of trained field researchers. RESULTS: This study included a total of 1193 men and 2863 women. Their age ranged from 18 to 90 year with a mean (SD) of 43.8 (14.2) year. WHtR performed better than other anthropometric measures and had a good ability (AUC > 0.80) among women and fair ability among men to predict newly diagnosed diabetes and previously diagnosed diabetes and hypertension. The appropriate cut-off points for anthropometric measures among women were 92 cm form WC, 104 cm for HC, 30 Kg/m2 for BMI, 0.85 for WHR, and 0.60 for WHtR. For men, the appropriate cut-off points were 100 cm for WC, 104 cm for HC, 27 Kg/m2 for BMI, 0.93 for WHR, and 0.57 for WHtR. CONCLUSION: WHtR performed better than other anthropometric measures in predicting diabetes and hypertension among adult population in Jordan. We recommend WHtR as a measure of choice with a cut-off value of 0.6 for women and 0.57 for men to predict diabetes and hypertension among Jordanians.

The prevalence and determinants of anaemia in Jordan.

BACKGROUND: Anaemia is a global public health problem particularly in low- and middle-income countries and may be associated with serious health consequences. Limited studies, if any, have examined the prevalence and risk factors of anaemia in Jordan at the national level. AIMS: This study aimed to assess the prevalence of anaemia in Jordan for both sexes at the national level and to identify high-risk population subgroups. METHODS: A national population-based household sample was selected from the 12 governorates of Jordan in 2017. A total of 1125 males and 2797 females aged between 18 and 90 years were included. The prevalence of anaemia, overall and among subgroups of the population was estimated using Hb level as per WHO definition. RESULTS: Results showed prevalence of anaemia to be 4.9% in males, 19.3% in non-pregnant females, and 27.4% in pregnant females. The age standardized prevalence rates were 4.9% in males and 19.3% in females. The age standardized prevalence rates were 4.9% in males and 19.3% in females. Anaemia was predominantly mild (males: 81%, non-pregnant females: 57%, and pregnant females: 65.2%). Sex, age, region, marital status, and education were significantly associated with anaemia. Iron deficiency anaemia (IDA) accounted for 68% of anaemic females and 38% of anaemic males. CONCLUSIONS: The prevalence of anaemia in Jordan is lower than previously reported by WHO and the majority of anaemia was mild. Iron deficiency anaemia was the the most common type of anaemia, particularly in females. Flour fortification with iron and folic acid could have accounted for the decline of anaemia in Jordan.

Hypertension in Jordan: Prevalence, Awareness, Control, and Its Associated Factors.

OBJECTIVES: Determine the prevalence, awareness, and control rates of hypertension and their associated factors among Jordanian adults. METHODS: A multistage sampling technique was used to select a nationally representative sample of adults from the population of Jordan. Trained interviewers collected data using a comprehensive structured questionnaire, measured anthropometric parameters, and collected blood samples. RESULTS: This study included a total of 1193 men and 2863 women aged ranged from 18 to 90 year with a mean (SD) of 43.8 (14.2) year. The age-standardized prevalence was 33.8% among men and 29.4% among women. Of those with hypertnsion, 57.7% of men and 62.5% of women were aware of hypertension. Only 30.7% of men and 35.1% of women who were on antihypertensive medications had their blood pressure controlled. From 2009 to 2017, there was nonsignificant decrease in hypertension prevalence of 2.7% among men and 1.1% among women. However, the rate of hypertension awareness increased significantly among men and among women. DISCUSSION: Almost one-third of Jordanian adults had hypertension. Interventions that target modifiable risk factors of hypertension, might decrease blood pressure, and even prevent the development of hypertension should be implemnted.

The prevalence of high risk obstructive sleep apnoea among patients with type 2 diabetes in Jordan.

OBJECTIVE: To estimate the prevalence of Obstructive Sleep Apnea (OSA) among patients with type 2 Diabetes Mellitus (T2DM) in Jordan, and to explore the association between sleep apnea and clinical and demographic variables. METHOD: A cross-sectional study was carried out from the 1st of November 2011 to the 1st of February 2012 on 1143 patients with T2DM (aged 30-90 years) at the National Center for Diabetes, Endocrinology, and Genetics (NCDEG). The center is considered to be the only referral center in the country and accordingly, the patients represent the population in different parts of the country. All participants completed the Arabic version of the Berlin Questionnaire and were categorized as either low or high-risk patients for OSA. RESULTS: A total of 1143 patients with T2DM were included in this study. There were 587 (51.4%) males and 556 (48.6%) females. The findings showed that 554 (48.5%) patients were at high risk for OSA and 589 (51.5%) were low risk for OSA. Logistic regression analysis revealed that age, smoking, and neck circumference were significantly correlated with high risk for OSA. The clinical and demographic variables were also collected for analysis. CONCLUSIONS: The study found that high risk for OSA was highly prevalent among Jordanian patients with T2DM and that age, smoking and neck circumference were significantly correlated with OSA. Health care providers should be made aware of the high prevalence of sleep problems affecting patients with diabetes and should consider the appropriate screening and treatment for these patients, therefore improving their quality of life.

Vitamin D deficiency and associated factors in Jordan.

BACKGROUND: In Jordan, many studies reported various rates of vitamin D deficiency and insufficiency among different groups. This study aimed to determine the prevalence of low vitamin D level among Jordanian adults and determine its association with selected variables. METHODS: The vitamin D level was assessed in a national representative sample of 4056 subjects aged >17 years. The study involved face-to-face interviews with the subjects and measurement of serum 25(OH)D. Low vitamin D level was defined as 25(OH)D < 30 ng/mL. Deficiency was defined as 25(OH)D < 20 ng/mL, and insufficiency was defined as 25(OH)D level of 20-30 ng/mL. RESULTS: The overall prevalence of low vitamin D status (25(OH)D < 30 ng/mL) was 89.7%, with higher prevalence in males (92.4%) than in females (88.6%). Vitamin D was sufficient in 7.6% of males, insufficient in 38.4% of males, and deficient in 54% of males. Among females, vitamin D was insufficient in 10.1% and deficient in 78.5%. The prevalence of vitamin D deficiency was much higher in females than in males (p = 0.001). The only variables that were significantly associated with low level of vitamin D were gender, age, obesity, and employment. CONCLUSION: The prevalence of low vitamin D level is extremely high in Jordan. Age, gender, obesity, and unemployment were associated with low levels of vitamin D. Health authorities in Jordan need to increase the level of awareness about vitamin D deficiency and its prevention, particularly among women.

The Prevalence of Dyslipidemia among Jordanians.

BACKGROUND: Dyslipidemia is one of the major modifiable risk factors for the development of cardiovascular disease and type two diabetes mellitus. Knowing the current prevalence of dyslipidemia is an important step for increasing awareness of the problem and for proper planning of health programs for prevention of its negative clinical effects. METHODS: A national population based household sample was selected from north, middle, and south regions of Jordan in 2017. A total sample of 4,056 aged between 18 and 90 years were included. Selected individuals were interviewed using a structured questionnaire and fasting blood samples were collected for biochemical measurements. RESULTS: The prevalence rates of hypercholesterolemia, hypertriglyceridemia, high LDL, and low HDL were 44.3%, 41.9% 75.9%, and 59.5%, respectively. Hypercholesterolemia in Jordan almost doubled from 23.0% in 1994 to 44.3% in 2017, and hypertriglyceridemia increased from 23.8% in 1994 to 41.9% in 2017. All lipid abnormalities decreased after the age of 60 years. Hypertension, diabetes, and obesity were all independently associated with hypercholesterolemia and hypertriglyceridemia. CONCLUSIONS: Results of this study show that dyslipidemia is a widely prevalent health problem among adult Jordanian population and that the problem has substantially increased since 1994. Encouraging healthy lifestyle and healthy diet are the basis for prevention of dyslipidemia.

Anxiety and Depression Among Adult Patients With Diabetic Foot: Prevalence and Associated Factors.

BACKGROUND: Diabetic foot is a frequent complication of diabetes mellitus with subsequent disturbances in the daily life of the patients. The co-existence of depression and anxiety among diabetic foot patients is a common phenomenon and the role of each of them in perpetuating the other is highlighted in the literature. Our study aimed to determine the prevalence rates of anxiety and depression, and to examine the associated risk factors among diabetic foot patients. METHODS: This is a cross-sectional study. A total of 260 diabetic foot patients in the Diabetic Foot Clinic at the National Center for Diabetes, Endocrinology and Genetics (NCDEG), Amman, Jordan, participated in the study. Sociodemographic and health data were gathered through review of medical charts and a structured questionnaire. Depression and anxiety status were also assessed. The Generalized Anxiety Disorder Scale (GAD-7) was used to screen for anxiety and the Patient Health Questionnaire (PHQ-9) was used to screen for depression. A cutoff of ≥ 10 was used for each scale to identify those who tested positive for anxiety and depression. RESULTS: Prevalence rate of anxiety was 37.7% and that of depression was 39.6%. Multiple logistic regression analysis showed that anxiety is positively associated with duration of diabetes of < 10 years (P = 0.01), with ≥ three comorbid diseases (P = 0.00), and HbA1c level of > 7% (P = 0.03). Multiple logistic regression analysis also showed that depression is positively associated with patients of < 50 years of age (P = 0.03), females (P = 0.01), current smokers (P = 0.01), patients with foot ulcer duration ≥ 7 months (P = 0.00), with ≥ three comorbid diseases (P = 0.00) than their counterparts. CONCLUSIONS: Anxiety and depression are widely prevalent among diabetic foot patients. Mental health status of those patients gets even worse among those suffering other comorbid diseases, which was a finding that requires special attention in the management of patients with diabetic foot.

Prevalence and Risk Factors of Osteoporosis Among Jordanian Postmenopausal Women Attending the National Center for Diabetes, Endocrinology and Genetics in Jordan.

To assess the prevalence of osteoporosis and osteopenia among Jordanian postmenopausal women attending the National Center for Diabetes, Endocrinology, and Genetics (NCDEG), and to determine the potential associated risk factors. A cross-sectional study was conducted at (NCDEG) in Amman, Jordan. A total of 1079 Jordanian postmenopausal women aged between 45 and 84 years were included in this study that was conducted during the period between April 2013 and December 2014. All patients underwent bone mineral density measurement through dual-energy X-ray absorptiometry (DEXA) scan. DEXA scan was interpreted in terms of T score as per World Health Organization guidelines. The overall prevalence of osteoporosis and osteopenia was 37.5% and 44.6%, respectively. The maximum prevalence of osteoporosis was observed at the lumbar spine (32.4%) followed by the left femoral neck (14.4%), while the maximum prevalence of osteopenia was observed at the left femoral neck (56.1%) followed by the lumbar spine (41.3%). Patients with longer menopausal duration, normal or overweight body mass index, high parity, physical inactivity, positive family history of osteoporosis, inadequate sun exposure, high daily caffeine intake, low daily calcium intake, and delay in the age of menarche were all positively associated with osteoporosis. On the other hand, women with type 2 diabetes mellitus had lower risk of osteoporosis. There is a high prevalence of osteoporosis and osteopenia among Jordanian postmenopausal women. Necessary steps are needed for more public education and a wider dissemination of information about osteoporosis and its prevention.

Hypertension Prevalence, Awareness and Control Levels among Ghawarna: An African-Descendant Ethnic Minority in the Jordan Valley.

OBJECTIVE: Treatment and control of hypertension (HTN) is a challenging issue as undiagnosed HTN prevalence seems to be high among certain ethnic groups, such as African-descendant populations. The current study attempted to measure HTN prevalence, awareness and control levels among Ghawarna, an African-descendant ethnic group living in the Jordan Valley (Al-Ghawr). DESIGN SETTING AND PARTICIPANTS: A cross-sectional study was conducted in a community of Ghawarna between March and June 2013 in Ghawr Al-Mazraa Village in the southern part of the Jordan Valley. A total of 517 participants, aged >25 years, were randomly selected using cluster random sampling technique. MAIN MEASURES: Data were collected using an interviewer-administrated questionnaire and on-location measurement of blood pressure (BP), height, and weight. Prevalence rates were compared by sex and age groups using chi-square test while backward selection logistic regression analysis was used to identify predictors of HTN. RESULTS: We found 229 (44.3%) of the 517 participants had HTN. Of those 229 hypertensives, 146 (28.2%) participants were discovered to have HTN for the "first time." Only 23 of the 83 who were aware of their hypertension had their BP controlled. When we added the undiagnosed HTN (n=146) to the uncontrolled HTN (n=60), the prevalence of uncontrolled HTN became 90% (206/229). Older age, higher BMI, diabetes mellitus, and dyslipidemia were associated with having HTN. CONCLUSIONS: HTN prevalence, awareness and control levels are alarming among Ghawarna.

Vitamin B12 deficiency in Jordan: a population-based study.

BACKGROUND: Vitamin B12 deficiency is highly prevalent worldwide and has been linked to hematologic, neurologic and psychiatric diseases. There are a few studies regarding vitamin B12 deficiency in developing countries in general and in Jordan in particular. OBJECTIVES: The aims of the present study were to assess the vitamin B12 status of Jordanians at national level and to identify population groups at high risk for vitamin B12 deficiency. METHODS: Vitamin B12 status was assessed in a national sample of 5,640 subjects aged >8 years. The study involved interviews, laboratory measurements of vitamin B12 and other parameters, and physical measurements. The present report deals exclusively with subjects aged >18 years (n = 2,847). RESULTS: The percentages of subjects with low (<200 pg/ml, n = 857), borderline (201-350 pg/ml, n = 382) and normal vitamin B12 level (>350 pg/ml, n = 1,608) were 30.1, 13.4 and 56.5%, respectively. Of the 382 subjects who had borderline vitamin B12 level, 61 subjects had both increased total homocysteine (tHcy; >13 µmol/l) and low holocobalamin (<35 pmol/l). Since elevated tHcy also indicates folate deficiency, the overall prevalence of vitamin B12 deficiency reached 32.2% (31.9% among males and 32.4% among females) after adding those 61 subjects to the 857 subjects with low vitamin B12 level. CONCLUSION: In conclusion, our study showed that almost one third of Jordanian adults have vitamin B12 deficiency with no gender differences. Intake of vitamin B complex and multivitamins seems to protect from vitamin B12 deficiency. An in-depth study of the dietary and eating habits of Jordanians may be needed to explain the observed age and regional differences in vitamin B12 deficiency in the study population.

Patterns of anterior abdominal stab wounds and their management at Princess Basma teaching hospital, North of Jordan.

BACKGROUND: With the progressive use of new diagnostic techniques, the management of penetrating abdominal stab wounds is changing. Most studies have been conducted in well-equipped trauma centers in developed countries, and there is a paucity of reports from general teaching hospitals with limited resources. We reviewed the assessment of anterior abdominal stab wounds in patients presenting to our hospital hoping to establish an evidence-based algorithm for managing such patients in busy general hospitals. METHODS: The medical records of all 393 patients treated at our hospital for anterior abdominal stab wounds over a 7-year period were reviewed. Information regarding age, gender, site of the stab wound, management, and complications were analyzed. RESULTS: Twenty-six patients with hemodynamic instability at presentation underwent urgent laparotomy (LAP); 24 (92.3 %) of those procedures were therapeutic. Local wound exploration (LWE) proved that 114 (31 %) of all hemodynamically stable patients had no abdominal fascia penetration and consequently could be discharged home from the emergency department (ED). A total of 253 patients were found to have fascial penetration, and all were admitted for repeat clinical assessments (RCA) and imaging studies. A total of 121 (48 %) of the patients underwent abdominal exploration with 102 (84 %) therapeutic LAP procedures. CONCLUSIONS: Hemodynamic instability and evisceration should continue to prompt urgent LAP. For stable patients, a sequence of LWE followed by focused abdominal sonography for trauma and computed tomography scanning for unclear cases primed by RCA was found to be efficient in limiting hospital admissions and reducing the rate of non-therapeutic LAP.

Comparison of plasma levels of natural anticoagulants (protein C and protein S) among Jordanian smokers and non-smokers.

BACKGROUND: Protein C (PC) with its cofactor free protein S (FPS) are important anticoagulants. Any defect in the PC system is a risk factor for venous thrombosis. AIMS: To assess the effect of intensity of smoking, and the dose-response for the number of cigarettes smoked on PC and FPS plasma levels. METHODS: A comparative study was designed and carried out on a convenient sample of 50 healthy non-smokers and 150 non-symptomatic Jordanian male smokers. PC and FPS levels were measured using an automated system (Stago Analyzer, USA). RESULTS: The plasma level of PC among smokers was 7.2% lower than that among non-smokers (p = 0.02). Moreover, smokers had 15.6% lower circulating FPS than non-smokers (p = 0.001). Furthermore, data showed significant negative correlations between both PC and FPS levels and the intensity of smoking (r = -0.21%, r = -0.23%, respectively; p = 0.01) and the period of smoking (r = -0.15%, r = -0.23%, respectively; p = 0.01, 0.12, respectively). CONCLUSIONS: The PC and FPS plasma levels were significantly lower in smokers than non-smokers. Both PC and FPS levels correlated inversely with the period and intensity of smoking, and FPS was more sensitive to smoking than PC.

Hypertension among 1000 patients with type 2 diabetes attending a national diabetes center in Jordan.

BACKGROUND AND OBJECTIVES: In Jordan, there is a paucity of research on hypertension and its risk factors among patients with type 2 diabetes mellitus. This study was designed to assess the prevalence of hypertension, risk factors, and the level of awareness and control of hypertension among outpatients with type 2 diabetes. SUBJECTS AND METHODS: A cross-sectional study was carried out on a sample of 1000 patients with type 2 diabetes who were attending the National Center for Diabetes, Endocrine and Genetic Diseases for follow-up during the period of June to December 2006. Data were collected from medical records and through a structured interview questionnaire. Logistic regression analysis was used to assess the independent effect of variables on hypertension. RESULTS: The prevalence of hypertension (BP >130/80 or on medication for high blood pressure) was 72.4% (70.9% of males and 73.9% of females). The logistic regression indicated that hypertension was positively associated with age (P=.001), body mass index (P=.001), and duration of diabetes (P=.001). About one-half of patients who were aware of having hypertension failed to keep their blood pressure under control. CONCLUSION: Hypertension is a common co-morbidity among diabetic patients. Despite a high rate of awareness of hypertension among study subjects (93%), hypertension was not controlled to the recommended levels of blood pressure in about one-half (50.4%) of patients.