Correction: Naser et al. Knowledge and Practices during the COVID-19 Outbreak in the Middle East: A Cross-Sectional Study. Int. J. Environ. Res. Public Health 2021, 18, 4699.

The authors would like to make the following corrections about the published paper [...].

The attitude and acceptability towards medical promotional tools and their influence on physicians' prescribing practices in Jordan and Iraq: a cross-sectional study.

BACKGROUND: Pharmaceutical companies spend more than one-third of their sales revenue on marketing and promotion directed toward healthcare professionals. There has been a focus on the relationship between healthcare professionals and the pharmaceutical industry in recent years. This study aims to explore the attitude toward and acceptability of medical promotional tools and their influence on physicians' prescribing practices in Jordan and Iraq. METHODS: A cross-sectional survey study was conducted to explore the influence of visits by medical representatives (MRs) and medical promotions on physicians' prescribing practices between June and October 2020 in Jordan and Iraq. Previously validated questionnaires were used. RESULTS: A total of 801 physicians completed the questionnaires. Face-to-face visits, followed by the dispensing of medical samples, were the two most common promotional methods used by MRs. 48% of participating physicians reported that they would accept the promotional marketing tools offered to them. MRs focused on the key selling points of their product during medical promotions, and 39.6% of the physicians reported that MRs had a negative attitude toward their competitors' products. 69.9% of the physicians reported that they would change their practice after participating in conferences or meetings. CONCLUSION: Medical promotional tools have a clear influence on physicians' prescribing practices in Jordan and Iraq. Therefore, medical promotion should be controlled and guided by clear and country-specific ethical guidelines. This will ensure safe medical promotion to physicians and optimise the healthcare practices provided to patients.

Hospital Admission Trends Due to Viral Infections Characterised by Skin and Mucous Membrane Lesions in the Past Two Decades in England and Wales: An Ecological Study.

OBJECTIVES: This study aimed to investigate the trends in hospital admissions due to viral infections characterized by skin and mucous membrane lesions in England and Wales between 1999 and 2019. METHODS: This is an ecological study using publicly available databases in England and Wales; the Hospital Episode Statistics database in England and the Patient Episode Database for Wales. Hospital admissions data were collected for the period between April 1999 and March 2019. Hospital admissions due to viral infections characterized by skin and mucous membrane lesions were identified using the tenth version of the International Statistical Classification of Diseases system, diagnostic codes B00-B09. The trend in hospital admissions was assessed using a Poisson model. RESULTS: Hospital admissions for different causes increased by 51.9% (from 25.67 (95% CI 25.23-26.10) in 1999 to 38.98 (95% CI 38.48-39.48) in 2019 per 100,000 persons, trend test, p < 0.01). The most prevalent viral infections characterized by skin and mucous membrane lesions hospital admissions causes were zoster (herpes zoster), varicella (chickenpox), herpesviral (herpes simplex) infections, and viral warts, which accounted for 26.9%, 23.4%, 18.7%, and 17.6%, respectively. The age group below 15 years accounted for 43.2% of the total number of admissions. Females contributed to 50.5% of the total number of admissions. Hospital admission rate in males increased by 61.1% (from 25.21 (95% CI 24.59-25.82) in 1999 to 40.60 (95% CI 39.87-41.32) in 2019 per 100,000 persons). The increase in females was 43.2% (from 26.11 (95% CI 25.49-26.72) in 1999 to 37.40 (95% CI 36.70-38.09) in 2019 per 100,000 persons). CONCLUSION: Our study demonstrates an evident variation in hospital admission of viral infections characterized by skin and mucous membrane lesions based on age and gender. Efforts should be directed towards vaccinating high-risk groups, particularly the elderly and females. Moreover, efforts should be focused on vaccinating the young population against varicella, particularly females who are more susceptible to acquiring the infection. Further observational and epidemiological studies are needed to identify other factors associated with increased hospital admission rates.

Trends of Hospital Admissions Due to Congenital Anomalies in England and Wales between 1999 and 2019: An Ecological Study.

Objectives: To investigate the trends in congenital anomalies-related hospital admissions in England and Wales. Methods: This was an ecological study that was conducted using hospital admission data taken from the Hospital Episode Statistics database in England and the Patient Episode Database for Wales. Congenital malformations, deformations and chromosomal abnormalities hospital admissions data were extracted for the period between April 1999 and March 2019. Results: Hospital admission rate increased by 4.9% [from 198.74 (95% CI 197.53-199.94) in 1999 to 208.55 (95% CI 207.39-209.71) in 2019 per 100,000 persons, trend test, p < 0.01]. The most common hospital admissions causes were congenital malformations of the circulatory system, the musculoskeletal system, genital organs, and the digestive system. The most notable increase in hospital admissions rate was observed in congenital malformations of the respiratory system (1.01-fold). The age group below 15 years accounted for 75.1% of the total number of hospital admissions. Males contributed to 57.5% of the whole number of hospital admission. Hospital admission rate between females was increased by 6.4% [from 162.63 (95% CI 161.10-164.16) in 1999 to 173.05 (95% CI 171.57-174.54) in 2019 per 100,000 persons]. Hospital admission rate between males was increased by 3.4% [from 236.61 (95% CI 234.72-238.50) in 1999 to 244.70 (95% CI 242.92-246.49) in 2019 per 100,000 persons]. Conclusions: Males had a higher percentage of hospitalisation compared to females. Further studies to investigate the factors associated with higher hospitalisation rate among males are needed.

Hospital Admissions Due to Ischemic Heart Diseases and Prescriptions of Cardiovascular Diseases Medications in England and Wales in the Past Two Decades.

OBJECTIVES: The aim of this study was to explore the trend of ischemic heart disease (IHD) admission and the prescriptions of IHD medications in England and Wales. METHODS: A secular trends study was conducted during the period of 1999 to 2019. We extracted hospital admission data for patients from all age groups from the Hospital Episode Statistics database in England and the Patient Episode Database for Wales. Prescriptions of IHD medications were extracted from the Prescription Cost Analysis database from 2004 to 2019. The chi-squared test was used to assess the difference between the admission rates and the difference between IHD medication prescription rates. The trends in IHD-related hospital admission and IHD-related medication prescription were assessed using a Poisson model. The correlation between hospital admissions for IHD and its IHD medication-related prescriptions was assessed using the Pearson correlation coefficient. RESULTS: Our study detected a significant increase in the rate of cardiovascular disease (CVD) medication prescriptions in England and Wales, representing a rise in the CVD medications prescription rate of 41.8% (from 539,334.95 (95% CI = 539,286.30-539,383.59) in 2004 to 764,584.55 (95% CI = 764,545.55-764,623.56) in 2019 prescriptions per 100,000 persons), with a mean increase of 2.8% per year during the past 15 years. This increase was connected with a reduction in the IHD hospital admission rate by 15.4% (from 838.50 (95% CI = 836.05-840.94) in 2004 to 709.78 (95% CI = 707.65-711.92) in 2019 per 100,000 persons, trend test, p < 0.01), with a mean decrease of 1.02% per year during the past 15 years and by 5% (from 747.43 (95% CI = 745.09-749.77) in 1999 to 709.78 (95% CI = 707.65-711.92) in 2019 per 100,000 persons, trend test, p < 0.01) with a mean decrease of 0.25% per year during the past two decades in England and Wales. CONCLUSION: The rate of hospitalisation due to IHD has decreased in England and Wales during the past two decades. Hospitalisation due to IHD was strongly and negatively correlated with the increase in the rates of dispensing of IHD-related medications. Other factors contributing to this decline could be the increase in controlling IHD risk factors during the past few years. Future studies exploring other risk factors that are associated with IHD hospitalisation are warranted.

Epidemiology of depression and anxiety among undergraduate students.

AIMS: Depression and anxiety are the most common and prevalent mental health issues among undergraduate students. This study aimed to investigate the prevalence of anxiety and depression, their associated predictors, and to assess knowledge and use of antidepressant medications among university students in Jordan. METHODS: A cross-sectional survey-based study was conducted in Jordan among undergraduate students from all levels of study. Istilli et al's questionnaire, the PHQ-9 and generalised anxiety disorder (GAD) scales were used in this study to explore the study objectives. Logistic regression analysis was used to identify predictors of anxiety and depression. RESULTS: A total of 1582 undergraduate students participated in the study. Prevalence of depression was 22.3% (n = 330), with proportions of minimal, mild, moderate, moderately severe and severe depression to be 15.9%, 32.4%, 29.5%, 14.7% and 7.6%, respectively. Prevalence of anxiety was 15.8% (n = 173), with proportions of mild, moderate and severe anxiety to be 46.4%, 37.8% and 15.8%, respectively. Female students and those with low income (<500 JD) had higher depression mean scores compared with others. Females, arts and engineering students, divorced and those who have four or more children had higher anxiety mean scores compared with others. CONCLUSION: Findings of this study addressed the importance of taking serious measures and interventions to prevent the development of severe mental illness among university students.

Knowledge and Practices during the COVID-19 Outbreak in the Middle East: A Cross-Sectional Study.

Objectives: This study aimed to assess the knowledge and practices of the general public in the Middle Eastern countries during the COVID-19 pandemic. Methods: A cross-sectional study using an online survey was conducted between the 19th of March and the 6th of April 2020 in three Middle Eastern countries (Jordan, Saudi Arabia, and Kuwait) to explore the knowledge and practices of the Middle Eastern population regarding COVID-19. A previously developed questionnaire was adapted and used for this study. Multiple linear regression analysis was used to identify predictors of COVID-19 knowledge. Results: A total of 1208 participants (members of the public) participated from the three countries (Jordan = 389, Saudi Arabia = 433, and Kuwait = 386). The majority of participants (n = 810, 67.2%) were females aged 30 to 49 years (n = 501, 41.5%). Participants had moderate overall COVID-19 knowledge, with a mean (SD) score of 7.93 (±1.72) out of 12 (66.1%). Participants had better knowledge about disease prevention and control (83.0%), whereas the lowest sub-scale scores were for questions about disease transmission routes (43.3%). High education level was an important predictor of greater COVID-19 knowledge scores (p < 0.01). Conclusions: Further public education is needed to address the relatively low level of education regarding the transmission of COVID-19 in the Middle Eastern countries. Policymakers are recommended to develop informative COVID-19 related campaigns that specifically target young people (university students), unemployed individuals, and those with lower levels of education.

Attitudes of pharmacy students towards patient safety: a cross-sectional study from six developing countries.

OBJECTIVE: To evaluate the attitudes of undergraduate pharmacy students towards patient safety in six developing countries. DESIGN: A cross-sectional study. SETTING: Participants were enrolled from the participating universities in six countries. PARTICIPANTS: Undergraduate pharmacy students from the participating universities in six developing countries (Jordan, Saudi Arabia, Kuwait, Qatar, India and Indonesia) were invited to participate in the study between October 2018 and September 2019. PRIMARY OUTCOME: Attitudes towards patient safety was measured using 14-item questionnaire that contained five subscales: being quality-improvement focused, internalising errors regardless of harm, value of contextual learning, acceptability of questioning more senior healthcare professionals' behaviour and attitude towards open disclosure. Multiple-linear regression analysis was used to identify predictors of positive attitudes towards patient safety. RESULTS: A total of 2595 students participated in this study (1044 from Jordan, 514 from Saudi Arabia, 134 from Kuwait, 61 from Qatar, 416 from India and 429 from Indonesia). Overall, the pharmacy students reported a positive attitude towards patient safety with a mean score of 37.4 (SD=7.0) out of 56 (66.8%). The 'being quality-improvement focused' subscale had the highest score, 75.6%. The subscale with the lowest score was 'internalising errors regardless of harm', 49.2%. Female students had significantly better attitudes towards patient safety scores compared with male students (p=0.001). Being at a higher level of study and involvement in or witnessing harm to patients while practising were important predictors of negative attitudes towards patient safety (p<0.001). CONCLUSION: Patient safety content should be covered comprehensively in pharmacy curricula and reinforced in each year of study. This should be more focused on students in their final year of study and who have started their training. This will ensure that the next generation of pharmacists are equipped with the requisite knowledge, core competencies and attitudes to ensure optimal patient safety when they practice.

Attitudes and perceptions towards hypoglycaemia in patients with diabetes mellitus: A multinational cross-sectional study.

BACKGROUND: Preventing hypoglycaemia is an essential component of diabetes self-management that is affected by patients' attitudes and perceptions. This study aimed to explore the hypoglycaemia problem-solving ability of patients who have diabetes mellitus and factors that determine their attitudes and perceptions towards their previous events. METHODOLOGY: A cross-sectional study was conducted between October 2017 and May 2018 in three Arab countries (Jordan, Saudi Arabia and Kuwait) in patients with diabetes mellitus, who were prescribed antidiabetic therapy and had experienced hypoglycaemic events in the past six months. The Hypoglycaemia Problem-Solving Scale was used in this study. This scale contains two subscales, problem orientation (six questions) and problem-solving skills (eighteen questions), using a five-point Likert scale (range 0-4). Multiple linear regression analysis was used to identify predictors of hypoglycaemia problem-solving abilities. RESULTS: A total of 895 patients participated in this study from the three countries (300 in Jordan, 302 in Saudi Arabia, and 293 in Kuwait). The average age of the patients was 53.5 years (standard deviation = 13.7) and 52.4% (n = 469) were males. Patients had moderate overall problem-solving ability with a median score of 63.00 (interquartile range = 13.00). Patients' problem-solving skills score (68.1%) was better than their problem-orientation skills score (58.3%). The highest sub-scale scores were for detection control, setting problem-solving goals, and evaluating strategies, 75.0%. The lowest sub-scale score was for problem-solving perception and immediate management, 50.0%. Older age, being educated, being married, having T2DM, prescribed insulin therapy, and not having been admitted to hospital for hypoglycaemia were important predictors of patients' problem-solving ability (p < 0.05). CONCLUSIONS: Healthcare professionals are advised to provide more education to patients on how to self-manage hypoglycaemic events. Specifically, they should focus on the overall problem-solving perception of hypoglycaemia and its immediate management.

A qualitative study exploring patients' experiences regarding insulin pump use.

BACKGROUND: Diabetes is a threat to peoples' lives around the world, particularly in the Middle East. Medicine misuse and poor glycaemic control are prevalent among patients with type 2 diabetes, especially insulin-dependent patients (Alsairafi et al., 2016). With advances in medical technology, insulin pumps became a treatment option for patients with type 1 diabetes and those with insulin-dependent type 2 diabetes. However, use of these devices is still lacking in Kuwait, particularly in patients with type 2 diabetes. Information on how patients manage these devices and their efficacy and safety from the perspectives of patients is also lacking (Alsaleh et al., 2016). OBJECTIVE: To examine the views and experiences of adults with type 2 diabetes regarding the use of insulin pumps compared to their previous insulin delivery methods, in terms of glycaemic control, quality of life, preference, convenience and adherence to doses. SETTING: The main five secondary-care hospitals in Kuwait: Mobarak Al-Kabeer, Al Amiri, Al Adan, Al Farwaniya and Al Jahra. METHOD: All adults with type 2 diabetes who used an insulin pump were invited to participate. Data were collected through semi-structured interviews. Data analysis was performed using MAXQDA-11. RESULTS: A total of eight patients were interviewed. Interviews with patients revealed that using an insulin pump improved patients' glycaemic control and quality of life as a consequence of improved satisfaction and adherence to doses. CONCLUSION: From the perspective of adults with type 2 diabetes, there are lots of benefits of using insulin pumps over other insulin delivery methods, mainly seen by the improvement of quality of life and patients' adherence to doses. Policy-makers and healthcare professionals (HCPs) must be aware of such benefits and should support the wider implementation of this technology in the country by including patients with type 2 diabetes. Results of this study will help to inform healthcare provision and guideline modifications and to provide guidance for new patients using this therapy.

Patients' management of type 2 diabetes in Middle Eastern countries: review of studies.

The increased prevalence of diabetes in Middle Eastern countries is a health policy priority. Important risk factors for diabetes have been identified. Lifestyle interventions and adherence to medications are central to disease prevention and management. This review focuses on the management of type 2 diabetes mellitus in Middle Eastern countries. The aim is to identify the ways in which knowledge, health beliefs, and social and cultural factors influence adherence to medication and lifestyle measures. Thirty-four studies were identified following a systematic search of the literature. The studies describe the influence of knowledge, health beliefs, culture, and lifestyle on the management of type 2 diabetes mellitus in the Middle East. Findings indicate a lack of health knowledge about diabetes among populations, which has implications for health behaviors, medication adherence, and treatment outcomes. Many identified health beliefs and cultural lifestyle factors, such as religious beliefs, beliefs about fasting during Ramadan, and sedentary lifestyles played a role in patients' decisions. For better management of this disease, a collaborative approach between patients, their families, health care professionals, and governments should be adopted. Implementing behavioral strategies and psychological interventions that incorporate all health care professionals in the management process have been shown to be effective methods. Such services help patients change their behavior. However, the utilization of such services and interventions is still limited in Arabian countries. Physicians in the Middle East are the health care professionals most involved in the care process.