Modifiable Factors and Delays Associated with Neonatal Deaths and Stillbirths in Jordan: Findings from Facility-Based Neonatal Death and Stillbirth Audits.

OBJECTIVE: This study employed the "three-delay" model to investigate the types of critical delays and modifiable factors that contribute to the neonatal deaths and stillbirths in Jordan. STUDY DESIGN: A triangulation research method was followed in this study to present the findings of death review committees (DRCs), which were formally established in five major hospitals across Jordan. The DRCs used a specific death summary form to facilitate identifying the type of delay, if any, and to plan specific actions to prevent future similar deaths. A death case review form with key details was also filled immediately after each death. Moreover, data were collected from patient notes and medical records, and further information about a specific cause of death or the contributing factors, if needed, were collected. RESULTS: During the study period (August 1, 2019-February 1, 2020), 10,726 births, 156 neonatal deaths, and 108 stillbirths were registered. A delay in recognizing the need for care and in the decision to seek care (delay 1) was believed to be responsible for 118 (44.6%) deaths. Most common factors included were poor awareness of when to seek care, not recognizing the problem or the danger signs, no or late antenatal care, and financial constraints and concern about the cost of care. Delay 2 (delay in seeking care or reaching care) was responsible for nine (3.4%) cases. Delay 3 (delay in receiving care) was responsible for 81 (30.7%) deaths. The most common modifiable factors were the poor or lack of training that followed by heavy workload, insufficient staff members, and no antenatal documentation. Effective actions were initiated across all the five hospitals in response to the delays to reduce preventable deaths. CONCLUSION: The formation of the facility-based DRCs was vital in identifying critical delays and modifiable factors, as well as developing initiatives and actions to address modifiable factors. KEY POINTS: · Death review committees play key roles in identifying critical delays and modifiable factors.. · The "three-delay" model was successful in identifying preventable neonatal deaths and stillbirths.. · Death review committees are central in developing actions to reduce preventable deaths..

Effectiveness of theory-based Multimedia Messaging Service (MMS) on exercise benefits and barriers among patients with type 2 diabetes.

The current study aimed to examine the effectiveness of multimedia messaging service (MMS) education on exercise benefits and barriers in patients with type 2 diabetes. A quasi-experimental, pretest-post-test design recruited 98 patients with type 2 diabetes. The intervention group received MMS education to improve perceived exercise benefits and decrease exercise barriers over two months, and the control group received routine care. All patients completed a survey at three time points (baseline, 4 and 8 weeks post-intervention). The results showed that there was an improvement in both perceived life enhancement and physical performance domains in the intervention group. The exercise context barriers decreased after the first follow-up but increased during the second follow-up in the intervention group. Cohen's d values indicated a medium effect size in life enhancement (0.502) and physical performance (0.525) subscales. A small effect size was found in psychological outlook (0.196) and exercise context (0.132) subscales. However, there was no significant effect of the intervention in time expenditure (-0.244) and physical exertion (-0.119) subscales. In conclusion, theoretically based MMS health education targeting perceived exercise benefits and barriers was feasible and cost-effective in changing patients with diabetes' perceptions and intended behaviors about regular physical activity.

Duty to Work During the COVID-19 Pandemic: A Cross-Sectional Study of Perceptions of Health Care Providers in Jordan.

INTRODUCTION: This study aimed to assess perceptions of duty to work among health care providers during the coronavirus disease 2019 response and to identify factors that may influence their perceptions. METHODS: This was a cross-sectional study conducted from April 1, 2020, to April 20, 2020, using an online survey distributed to health care providers in Jordan. Descriptive statistics were used, as well as chi-square test for independence to assess relationships between variables. RESULTS: A total of 302 questionnaires were included. Commitment to serve the community was the primary reason for coming to work (36%), followed by commitment to faith (29.6%). The major perceived barriers for coming to work were lack of appropriate personal protective equipment and appropriate training (62.6% and 53.5%, respectively). Males perceived higher work obligations than females in all potential barriers (P < .05), except for the lack of appropriate training. Nurses perceived higher work obligations than other health care providers despite the lack of appropriate training (χ2 = 11.83, P = .005), lack of effective vaccine or treatment (χ2 = 21.76, P < .001), or reported infection among coworkers (χ2 = 10.18, P = .03). DISCUSSION: While the majority of health care providers perceive an obligation to work during the coronavirus disease 2019 pandemic, specific conditions, mainly lack of protective gear and training, may significantly alter their perception of work obligation. Providing training and proper personal protective equipment are among the vital measures that could improve the work environment and work obligation during pandemic conditions.

Challenges Faced by Behavioral Genetic Studies: Researchers Perspective from the MENA Region.

Background: Behavioral genetic studies are important for the understanding of the contribution of genetic variations to human behavior. However, such studies might be associated with some ethical concerns. Methods: In the current study, ethical challenges related to studies of genetic variations contributing to human behavior were examined among researchers. To achieve the study purpose, the Middle East and North Africa (MENA) region researchers were taken as an example, where the after- mentioned ethical challenges were discussed among a group of researchers, who were the participants of an online forum. Discussions and responses of the participants were monitored and were later qualitatively analyzed. Results: Discussions revealed that several ethical challenges, including subjects' recruitment, the difficulty of obtaining informed consents, and issues of privacy and confidentiality of obtained data as information leakage, in this case, will lead to social stigma and isolation of the participants and their immediate family members. Jordanian social and cultural norms, faith, and the tribal nature of the population were raised as a major challenge that might face conducting behavioral genetic studies in the Arab populations of the MENA. The lack of regulation related to the conduction of genetic studies, misunderstanding, and misuse of genetic information are other challenges. A full explanation of genetic research and the current and future possible benefits/risks of such research could be potential solutions. Conclusion: In conclusion, the MENA populations are tackled with major challenges in relation to conducting research studies in genetics/antisocial behavior field/s. Establishment of guidelines related to genetic studies, capacity building, increasing public awareness about the importance of genetic testing, and enhancing responsible conduct of research will facilitate the conduct of such sensitive studies in the future in the region.

The Jordan Stillbirth and Neonatal Mortality Surveillance (JSANDS) System: Evaluation Study.

BACKGROUND: The Jordan Stillbirth and Neonatal Mortality Surveillance (JSANDS) is an electronic surveillance system that automatically transfers the data on births, stillbirths, and neonatal deaths to the concerned authorities in the Ministry of Health. JSANDS was implemented and tested in 5 maternity hospitals during the period spanning May 2019 through December 2020. OBJECTIVE: This study aimed to evaluate the usefulness and performance of JSANDS to register births, stillbirths, and neonatal deaths, and determine their causes. Specifically, this study examined the JSANDS attributes of acceptability, simplicity, flexibility, stability, representativeness, sustainability, penetration, data quality, sensitivity, and adoption. METHODS: An evaluation study was conducted after 18 months of the JSANDS implementation using the Updated Guidelines for Evaluating Public Health Surveillance Systems. The evaluation focused on how well the system operated to meet its purpose and objectives. The indicators assessing the system attributes were scored on a Likert scale. Each indicator and overall attribute percentage score was represented as score rank and interpreted as excellent (score ≥80%), good (score ≥60 and <80%), average (score ≥40 and <60%), and poor (score <40%). RESULTS: A total of 270 health care professionals participated in this study and evaluated the system performance. The system users rated the usefulness of JSANDS as excellent (percentage score=85.6%). The overall acceptability (percentage score=82.3%), flexibility (percentage score=80.2%), stability (percentage score=80.0%), and representativeness (percentage score=86.6%) were also rated excellent. The overall simplicity was scored good (percentage score=75.4%). All participants were trained on JSANDS and used it in the past 12 months. Of the 270 respondents, 219 (86.2%) reported that they intend to continue using the JSANDS system to register neonatal deaths and stillbirths in the future. All variables in JSANDS had complete data with no missing values. CONCLUSIONS: The performance of JSANDS in registering all stillbirths and neonatal deaths as well as their causes was excellent. Almost all attributes and indicators of JSANDS functionality were rated excellent. JSANDS can be scaled up to cover all maternity hospitals in Jordan. The potential for scaling up the system is very high for many reasons, including its usefulness, simplified stillbirth and neonatal death review tools, and ease of the reporting process.

Perceptions Toward the Use of Digital Technology for Enhancing Family Planning Services: Focus Group Discussion With Beneficiaries and Key Informative Interview With Midwives.

BACKGROUND: Modern family planning (FP) methods allow married couples to discuss and determine the number of children and years of spacing between them. Despite many significant improvements in FP services in Jordan, there are still many issues related to the uptake of FP services for both host communities and Syrian refugees, due to limitations in the health care system based on public health facilities. Digital technologies can provide opportunities to address the challenges faced in the health system, thus offering the potential to improve both coverage and quality of FP services and practices. OBJECTIVE: The aim of this study was to explore the perceptions of Jordanian women, Syrian refugees, and midwives in Jordan toward the use of digital health technology to support and enhance access to FP services. METHODS: We employed a qualitative study based on semistructured, face-to face key informative interviews with 17 midwives (providers) and focus group discussions with 32 married women of reproductive age (clients). Both midwives and clients were recruited from 9 health centers in 2 major governorates in Jordan (Irbid and Mafraq), where 17 in-depth interviews were conducted with midwives and 4 focus groups were conducted with the women. Each focus group included 4 Syrian refugees and 4 Jordanian women. The transcribed narratives were analyzed using inductive thematic analysis. RESULTS: Three major themes were derived from the narratives analysis, which covered the pros of using digital technology, concerns about digital technology use, and the ideal app or website characteristics. Ten subthemes emerged from these 3 main themes. Overall, midwives and women (Syrian refugees and host communities) agreed that digital technology can be feasible, cost-effective, well accepted, and potentially beneficial in increasing woman's awareness and knowledge regarding the FP methods and their side effect. Furthermore, digital technology can assist in enabling women's empowerment, which will allow them to make better decisions regarding FP use. No harmful risks or consequences were perceived to be associated with using digital technology. However, several concerns regarding digital technology use were related to eHealth literacy and the accuracy of the information provided. Midwives were mainly concerned about the patients who would rely mostly on the technology and choose to avoid consulting a health care professional. CONCLUSIONS: As perceived by midwives and women, incorporating digital technology in FP services can be feasible, cost-effective, well accepted, and potentially beneficial in increasing woman's awareness regarding the FP methods and their side effect. It may also empower the women to play an active role in the shared (with their husband and family) decision-making process. Therefore, digital technologies are recommended to address the challenges faced in health system and to improve both the coverage and the quality of FP services and practices.

Rate, determinants, and causes of stillbirth in Jordan: Findings from the Jordan Stillbirth and Neonatal Deaths Surveillance (JSANDS) system.

BACKGROUND: Annually, 2.6 million stillbirths occur around the world, with approximately 98% occurring in low- and middle-income countries. The stillbirth rates in these countries are 10 times higher than the rates in high-income countries. METHODS: An electronic stillbirths and neonatal deaths surveillance system (JSANDS) was established in five large hospitals located in three of the largest cities in Jordan in August 2019. JSANDS was developed as a secure on-line data entry system to collect, organize, analyze, and disseminate data on stillbirths, neonatal deaths, and their contributing conditions. Data on births, stillbirths and their contributing conditions, and other demographic and clinical characteristics in the period between August 2019 - January 2020 were extracted and analyzed. RESULTS: A total of 10,328 births were registered during the reporting period. Of the total births, 102 were born dead (88 antepartum stillbirths and 14 intrapartum stillbirths), with a rate of 9.9 per 1000 total births. The main contributing fetal conditions of antepartum stillbirths were antepartum death of unspecified cause (33.7%), acute antepartum event (hypoxia) (33.7%), congenital malformations and chromosomal abnormalities (13.3%), and disorders related to the length of gestation and fetal growth (10.8%). The main contributing maternal conditions of antepartum stillbirths included complications of the placental cord and membranes (48.7%), maternal complications of pregnancy (23.1%), and maternal medical and surgical conditions (23.1%). Contributing fetal conditions of intrapartum stillbirths included congenital malformations, deformations and chromosomal abnormalities, other specified intrapartum disorders, and intrapartum death of unspecified cause (33.3% each). Contributing maternal conditions of intrapartum stillbirths included complications of the placental cord and membranes. In the multivariate analysis, small for gestational age (SGA) pregnancies were associated with a significant 3-fold increased risk of stillbirth compared to appropriate for gestational age (AGA) pregnancies. CONCLUSIONS: Although the rate of stillbirth is lower than that in other countries in the region, there is an opportunity to prevent such deaths. While the majority of stillbirths occurred during the antepartum period, care should be taken for the early identification of high-risk pregnancies, including the early detection of SGA pregnancies, and ensuring adequate antenatal obstetric interventions.

Gender-Specific Blood Pressure and Heart Rate Differences in Adolescents Smoking Cigarettes, Waterpipes or Both.

Background: The effect of concurrent cigarette and waterpipe (i.e. both) smoking on cardiovascular function is still a scarce, especially among adolescents. Objective: Therefore, the study aimed at comparing cardiovascular measures among adolescents smoking cigarettes, waterpipe, or both, versus never smoking. Methods: Self-reported smoking status and cardiovascular measures were obtained from 771 boys (n = 475) and girls (n = 296) in the 7th-10th grade. Results: Stepwise regression showed that smoking explained (p < .05) 4.8% of heart rate, 6.1% of diastolic blood pressure, 3.9% of mean arterial pressure, 2.8% of pulse pressure, and 4.0% of rate pressure products. The gender-stratified one-way (4 smoking group) ANCOVA revealed greater (p < .05) heart rate and diminished (p < .05) diastolic blood pressure, mean arterial pressure, and rate pressure product in the boys smoking cigarettes, waterpipe, or both versus the ones never smoked, but not in the girls. No differences (p > .05) were found between the smoking groups (cigarettes, waterpipe, versus both). Conclusions: The study indicates that cardiovascular measures are equally altered among the boys, but not the girls, smoking cigarettes, waterpipe, or both as compared to the ones never smoked.

Do modern family planning methods impact women's quality of life? Jordanian women's perspective.

BACKGROUND: Although Jordan has made progress in meeting Family Planning (FP) needs in last decades, recently the use of FP methods has declined significantly. Women's personal experiences, knowledge, and perceptions of how a FP method might impact their quality of life (QoL) can influence FP decisions. However, a lack of comprehensive understanding of the impact of modern FP methods on women's QoL continues to exist among Jordanian couples. Therefore, this study aimed to investigate the relationship between the use of common modern FP methods and QoL among Jordanian women. METHODS: Using the WHOQOL-BREF questionnaire along with other questions, non-pregnant women of reproductive age were interviewed at their homes through face-to-face structured interviews. Women who visited the obstetrics and gynecology clinic of King Abdullah University Hospital for contraceptive advice and follow-up consultations were also included. RESULTS: A total of 548 women aged between 18 and 49 participated in the study. Based on the WHOQOL-BREF scale, the overall mean (SD) scores of the four domains were found to be average. Our findings show that women who used Intra Uterine Devices (IUDs) and women whose husbands used condoms had better QoL in the four domains (physical health, psychological health, social relationships, and environment) than those who used Oral Contraceptives (OCs). Women who used implant and injectable hormonal contraceptives had better QoL in terms of the physical health and social relationships domains. In contrast, women who had undergone permanent sterilization had lower QoL scores in all of the four domains. Further analysis revealed that women who had undergone tubal sterilization were less satisfied overall and more likely to experience side effects than women who used OCs. CONCLUSION: The choice to use contraceptives and decide freely whether and when to have children is regarded as a fundamental reproductive health right and is strongly linked to women's health and QoL. Women who use OCs and women who have undergone permanent sterilization are likely to have lower QoL than women who use IUDs or implant and injectable hormones and those whose husbands use condoms.

Individual-level determinants of waterpipe smoking demand in four Eastern-Mediterranean countries.

The prevalence of waterpipe tobacco smoking in the Eastern Mediterranean Region is at alarmingly high levels, especially among young people. The objective of this research was to evaluate the preferences of young adult waterpipe smokers with respect to potential individual-level determinants of waterpipe smoking using discrete choice experiment methodology. Participants were young adult university students (18-29 years) who were ever waterpipe smokers, recruited from universities across four Eastern Mediterranean countries: Jordan, Oman, Palestine and the United Arab Emirates. The Internet-based discrete choice experiment, with 6 × 3 × 2 block design, evaluated preferences for choices of waterpipe smoking sessions, presented on hypothetical waterpipe café menus. Participants evaluated nine choice sets, each with five fruit-flavored options, a tobacco flavored option (non-flavored), and an opt-out option. Choices also varied based on nicotine content (0.0% vs. 0.05% vs. 0.5%) and price (low vs. high). Participants were randomized to receive menus with either a pictorial + text health-warning message or no message (between-subjects attribute). Multinomial logit regression models evaluated the influence of these attributes on waterpipe smoking choices. Across all four samples (n = 1859), participants preferred fruit-flavored varieties to tobacco flavor, lower nicotine content and lower prices. Exposure to the health warning did not significantly predict likelihood to opt-out. Flavor accounted for 81.4% of waterpipe smoking decisions. Limiting the use of fruit flavors in waterpipe tobacco, in addition to accurate nicotine content labeling and higher pricing may be effective at curbing the demand for waterpipe smoking among young adults.

The Effect of a "Class Smoke Free Pledge" on Breath Carbon Monoxide in Arabic Male Adolescents.

Introduction: Arabic male adolescents have a high smoking prevalence. Introduction of "Class smoke-free" pledges have been successful amongst European adolescents but have not been evaluated using objective valid measures. We tested the impact of adding a smoke free pledge strategy to a proven peer-led asthma and smoking prevention program on breath carbon monoxide level (BCO) in male high-school students in Jordan. Methods: We enrolled male students from four high-schools in Irbid, Jordan. Schools were randomly assigned to receive either TAJ (Triple A in Jordan, n = 218) or TAJ-Plus (with added class smoke-free pledge, n = 215). We hypothesized that students receiving TAJ-Plus would have greater reduction in BCO levels than those only receiving the TAJ intervention. Asthma and smoking status were assessed by self-administered questionnaires. Smoking outcomes were collected using a BCO Monitor. Results: Both groups had significant reductions in BCO levels post-intervention (p < .0001), however, decreases were greater in TAJ-Plus group (3.9 ± 0.2 vs. 4.8 ± 0.2, p < .0001). Intervention effects on BCO over time did not vary by smoking status (p = .085), asthma status (p = .602), or a combination of the two (p = .702). Conclusions: An added smoke-free pledge strategy to a proven peer-led asthma education program appears to be a promising approach to motivate adolescents to abstain from smoking in Jordan. Future research is required to determine if these results can be extended to Jordanian adolescent females. Implications: A commitment by students via a "class smoke-free" pledge can be an added incentive to motivate adolescents in Arabic-speaking countries to abstain from smoking. Social influence approaches in schools can be useful in countering the aggressive tobacco marketing campaigns targeting Jordanian and other Arabic-speaking youth. The combination of "class smoke-free" pledges and an evidence-based peer-led asthma and smoking education can be implemented in schools to influence adolescents with asthma to abstain from smoking.

Memory and potential correlates among children in Jordan.

BACKGROUND: Cognitive functioning hugely affects the performance of tasks of different complexity. Memory, one of the most important cognitive skills, allows children to practice and acquire necessary skills and knowledge and interact with the surrounding environment. Therefore, it is crucial to study the factors that influence the memory of children. The main purpose of his study was to investigate different variables related to memory in school aged children (5-9 years, N = 434). METHODS: Parents of the participants provided information about child's daily behavior, child's school academic achievement, work and family income data and demographics. Memory skills in children were assessed by using the Leiter International Performance Scale -Revised. RESULTS: The score of memory increased 2.53 points with upsurge in maternal occupation level, 3.08 points when the child ate breakfast and 4.51 points when the child daily slept nine hours and more. By contrast, increased family income and smoking by father resulted in decreased scores in memory. CONCLUSION: Screening for and understanding of memory and relevant factors are vital for broad understanding of children's capabilities and weaknesses as well as for developing appropriate interventions.

Plasma and saliva levels of three metals in waterpipe smokers: a case control study.

In this case-control study, the influence of waterpipe tobacco smoking on the plasma and saliva levels of cadmium, lead and zinc was examined in participants who were waterpipe tobacco smokers (WS) or never-smokers (NS). The concentration of metals was higher in WS relative to NS. The mean (SEM) cadmium concentration in plasma was 3.3 (0.18) µg/dL in WS versus 0.82 (0.09) µg/L in NS (p < .001) and in saliva was 5.1 (0.36) µg/L in WS versus 0.64 (0.2) µg/L in NS (p < .001). The mean (SEM) lead concentration in plasma was 5.2 (0.25) µg/dL in WS versus 3.4 (0.41) µg/dL in NS (p < .01) and in saliva was 4.8 (0.58) µg/L in WS versus 2.8 (0.27) µg/L in NS (p < .05). Similarly, a significant difference in zinc concentration was observed, with a mean of 2.0 (0.17) µg/mL in WS plasma versus 1.49 (0.16) µg/mL in NS (p < .05) and a mean 0.94 (0.07) µg/mL in WS saliva versus 0.45 (0.06) µg/mL in NS (p < .01). In conclusion, waterpipe tobacco smoking is associated with elevated levels of metals in body fluids. These results provide another demonstration of how waterpipe tobacco smoking exposes smokers to harmful toxicants.

Adolescent Waterpipe Use is Associated with Greater Body Weight: The Irbid-TRY.

BACKGROUND: Adult waterpipe smokers are at increased risk of obesity. However, it is unclear if adolescents, who are at the epicenter of the global waterpipe epidemic, are at similar risk. OBJECTIVE: Therefore, the current study examined the waterpipe smoking relationship with obesity among adolescents. METHODS: A sample of 2,313 boys and girls in grades 7-10 were surveyed about waterpipe and cigarette use in Jordan. Weight, body mass index (BMI), waist circumference, waist-to-hip ratio, and waist-to-height ratio were measured. Obesity indices were assessed as a function of smoking status (never used tobacco, current waterpipe only, current cigarettes only, and current dual smoking) as well as frequency of use of each tobacco product. RESULTS: About 51.5% of adolescents smoked waterpipe whereas 29.8% were overweight/obese. Students who smoked waterpipe weekly had twofold greater odds of being obese than never-smokers (OR = 2.14; 95% CI = 1.08-4.21). Approximately 12% of students currently smoked waterpipe but not cigarettes, 2% smoked cigarettes but not waterpipe, and 11% smoked both. Body weight and age- and gender-specific BMI were greater for waterpipe and dual users compared to never users, especially for dual vs. never users (58.6 ±.8 vs. 55.6 ±.4 and.48 ±.07 vs..29 ±.03, respectively; p <.005). CONCLUSIONS: For dual users, greater frequency of tobacco use was associated with greater weight and BMI. Waterpipe and dual use is associated with greater obesity, BMI, and body weight among Jordanian adolescents. Given the rising epidemics of both tobacco use and obesity among Middle Eastern adolescents, the clustering of these risk factors warrants public health action.

Effectiveness of a 12-week school-based educational preventive programme on weight and fasting blood glucose in "at-risk" adolescents of type 2 diabetes mellitus: Randomized controlled trial.

To assess the effectiveness of a 12-week school-based educational preventive programme for type 2 diabetes by change in weight and fasting blood glucose level in Jordanian adolescents. Sixteen percent of Jordanian adults have obesity-related type 2 diabetes and 5.6% of obese adolescents examined, however one-third unexamined. Rates in Arabic countries will double in 20 years, but this can be prevented and reversed by controlling obesity. A single-blinded randomized controlled trial was conducted in 2 unisex high schools in Irbid, Jordan, in 2012. Intervention and control participants, aged 12 to 18 years, were visibly overweight/obese. They were randomly allocated to the intervention (n = 205) or control (n = 196) groups. At-risk students were assessed before and after the 12-week intervention, for change in weight and fasting blood glucose level following preventive instruction and parent-supported changes. Mean age of participants was 15.3 years with equal percentages of both males (49.4%) and females. Post intervention, the intervention group, demonstrated statistically significant reductions: mean difference of 3.3 kg in weight (P < .000) and 1.36 mg/dL (0.075 mmol/L) in fasting blood glucose (P < .000). School-based early prevention intervention effectively reduced weight and fasting blood glucose in Jordanian at-risk adolescents.

Investigating the Effects of Exposure to Waterpipe Smoke on Pregnancy Outcomes Using an Animal Model.

INTRODUCTION: In recent years, waterpipe tobacco smoking has been increasing in popularity all over the world. In this study, we explored effects of waterpipe smoking on pregnancy outcomes in rats. METHODS: Animals were exposed to waterpipe tobacco smoking using a whole body exposure system 2 hours per day during pregnancy. A control group was exposed to fresh air only. RESULTS: The results showed significant association between exposure to waterpipe smoke during pregnancy and low birth weight (P < .01) and neonatal death (P < .01). In addition, the rate of growth of offspring of the waterpipe group was significantly lower than that of control group as measured by body weight gain during the first 3 months of life (P < .001). No effect was found for waterpipe smoking on mean number of progeny and male to female ratio among offspring. CONCLUSION: Waterpipe smoking is associated with adverse effects on pregnancy outcomes. IMPLICATIONS: In this study, we investigated for the first time the effect of waterpipe smoking on pregnancy outcomes using animal model. The results clearly showed that waterpipe smoking is associated with adverse effects on pregnancy outcomes that include low birth weigh, neonatal survival, and growth retardation.

Cigarette smoking lowers blood pressure in adolescents: the Irbid-TRY.

OBJECTIVE: Tobacco consumption adversely affects cardiovascular (CV) disease (CVD) and risk profile, including hypertension. The long-term effect of cigarette smoking on blood pressure (BP) in adolescents is still, however, equivocal. Thus, the current study examined the CV indices in male adolescent cigarette smokers versus nonsmokers. METHOD: Resting heart rate, systolic BP (SBP) and diastolic BP (DBP), mean arterial pressure (MAP), pulse pressure (PP) and rate pressure products (RPP) were examined using automatic oscillatory method, while smoking status was determined with Youth Risk Behavior Survey. RESULTS: After controlling for cofactors, the ANCOVA showed that CV measures in the male adolescent smokers were lower (p < 0.05) than nonsmokers. Additionally, regression showed that smoking status explained 20.6% of SBP, 5.0% of DBP, 13.4% of MAP, 7.5% of PP and 13.4% of RPP. CONCLUSION: The results suggest that cigarette smoking lowers CV measures in adolescents. However, more studies are needed to describe the mechanism(s) for lowering CV measures and explain the relationship of adolescent smoking with adulthood CVDs.

Anthropometric measurements of newborns of women who smoke waterpipe during pregnancy: a comparative retrospective design.

Waterpipe tobacco smoking carries adverse health consequences due to high level of chemical toxicants. This study investigated the anthropometric measurements of singleton newborns of Jordanian women with no known chronic diseases who smoked waterpipe during pregnancy, and the difference in these measurements in newborns of pregnant women who smoked waterpipe, cigarettes, both types, and none during pregnancy. The study also investigated the pattern of different types of tobacco smoking as a function of pregnancy trimester. A descriptive, comparative, retrospective, cross-sectional design was used. Two hundred and eight-five women (74 waterpipe, 84 cigarettes, 26 dual, 101 none) and their newborns were recruited from three hospitals. A questionnaire was used while interviewing mothers to assess tobacco smoking pattern. The results showed that compared with non-smokers, mean birth weight was 0.47 kg (95%CI = -0.70 to -0.35) lower for waterpipe-only smokers, 0.23 kg (95%CI = -0.41 to -0.8) lower for cigarette-only users, and 0.59 kg (95%CI = -0.81 to -0.31) lower for dual users. Compared to non-smokers, mean newborn length was 2.7 cm (95%CI = -3.80 to -1.42) lower for dual smokers, 2.2 cm (95%CI = -3.28 to -1.58) lower for waterpipe smokers, and 1.2 cm (95%CI = -2.01 to -0.45) lower for cigarette smokers. Compared with non-smokers, mean newborn head circumference was 1.9 cm (95%CI = -2.72 to -1.65) lower for waterpipe smokers, 1.7 cm (95%CI = -2.65 to -1.16) lower for dual smokers, and 0.8 cm (95%CI= -1.34 to -0.36) lower for cigarette smokers. From these results, we may conclude that waterpipe tobacco smoking during pregnancy can contribute to a reduction in newborn's anthropometric measurements. Increasing awareness of waterpipe tobacco smoking adverse effects and developing cessation interventions in pregnancy is needed.

Level, Causes and Risk Factors of Neonatal Mortality, in Jordan: Results of a National Prospective Study.

OBJECTIVE: The present study aimed at assessment of the magnitude of neonatal mortality in Jordan, and its causes and associated factors. METHODS: Through a multistage sampling technique, a total of 21,928 deliveries with a gestational period ≥20 weeks from 18 hospitals were included in the study. The status of their babies 28 days after birth, whether dead or alive, was ascertained. Extensive data were collected about mothers and their newborns at admission and after 28 days of birth. Causes of death were classified according to the neonatal and intrauterine death classification according to etiology. Preventability of death was classified according to Herman's classification into preventable, partially preventable, and not preventable. RESULTS: Neonatal mortality rate, overall and for subgroups of the study was obtained. Risk factors for neonatal mortality were first examined in bivariate analyses and finally by multivariate logistic regression models to account for potential confounders. A total of 327 babies ≥20 weeks of gestation died in the neonatal period (14.9/1000 LB). Excluding babies <1000 g and <28 weeks of gestation to be consistent with the WHO and UNICEF's annual neonatal mortality reports, the NNMR decreased to 10.5/1000 LB. About 79 % of all neonatal deaths occurred in the first week after birth with over 42 % occurring in the first day after birth. According to NICE hierarchical classification, most neonatal deaths were due to congenital anomalies (27.2 %), multiple births (26.0 %), or unexplained immaturity (21.7 %). Other important causes included maternal disease (6.7 %), specific infant conditions (6.4 %), and unexplained asphyxia (4.9 %). According to Herman's classification, 37 % of neonatal deaths were preventable and 59 % possibly preventable. An experts' panel determined that 37.3 % of neonatal deaths received optimal medical care while the medical care provided to the rest was less than optimal. After adjusting for socio-demographic characteristics, type of the hospital, and clinical and medical history of women, the following variables were significantly associated with neonatal mortality: male gender, congenital defects, inadequate antenatal visits, multiple pregnancy, presentation at delivery, and gestational age. CONCLUSION: The present study showed the level, causes, and risk factors of NNM in Jordan. It showed also that a large proportion of NNDs are preventable or possibly preventable. Providing optimal intrapartum, and immediate postpartum care is likely to result in avoidance of a large proportion of NNDs.

Gender-specific differences in plasma ferritin in adolescents smoking cigarettes versus waterpipe smoking: the Irbid-TRY Project.

Introduction: Ferritin has been implicated in body physiology and pathology. Smoking cigarettes (Cg) alters ferritin metabolism. Waterpipe (Wp) smoking has recently reemerged as a global epidemic and is linked to the most devastating diseases. However, the effect of smoking Wp on ferritin is not known. Therefore, the current study compared plasma ferritin in adolescents smoking Cg, Wp, both (CgWp) versus never smoked. Material and methods: Self-reported smoking status and plasma ferritin levels were obtained from 849 boys (n = 470) and girls (n = 379) in the 7th-10th grade (age range = 13-17 years). Results: The ANCOVA revealed a main effect for gender (p < 0.000) and smoking status (p < 0.02) without an interaction effect (p > 0.9). Post-hoc analysis showed greater plasma ferritin in the adolescents smoking Wp (p < 0.03) and CgWp (p < 0.004) versus never smoked. Gender-stratified ANCOVA showed a main effect for smoking status in the boys (p < 0.02) and girls (p < 0.03). Additional comparisons among the boys showed greater plasma ferritin in the Wp (p < 0.006) and CgWp (p < 0.008) smoking groups versus never smoking, without differences (p > 0.5) between Wp and CgWp smoking. Another subgroup comparison showed greater plasma ferritin in the girls smoking Cg (p < 0.02) and CgWp (p < 0.02) versus never smoking, without a difference (p > 0.3) between Cg and CgWp smoking. Conclusions: The results indicate that ferritin is elevated in adolescent smokers, particularly the boys smoking Wp and CgWp and in the girls smoking Cg and CgWp.