Self-medication with antibiotics in Jordanian population.

OBJECTIVES: A survey was conducted to estimate the prevalence of self-medication with antibiotics in Jordan and evaluate the factors associated with antibiotic misuse. METHODS: Validated questionnaire was used to collect data from a sample of 1943 households (9281 persons) selected from among different cities in Jordan. RESULTS: 842 (39.5%) of 2133 antibiotic users identified via the survey had used antibiotics without a prescription within a one-month study period. Self-medication with antibiotics was found to be significantly associated with age, income, and level of education. The main reason for self-medication as reported by the participants was their previous experience on the efficacy of treatment. The main sources of antibiotics were the previously prescribed pharmaceuticals stored in the household and those purchased in pharmacies. CONCLUSION: The prevalence of self-medication with antibiotics in Jordan is alarmingly high. Given the growing global resistance to antibiotics and the documented health problems related to their inappropriate use, our findings may have major public health policy implications in Jordan.

Suppression of apolipoprotein AI gene expression in HepG2 cells by TNF alpha and IL-1beta.

Plasma inflammatory cytokines are elevated in obese subjects as well as in those with type 2 diabetes. This presumably results in systemic insulin resistance, characterized by a pro-atherogenic plasma lipid profile and reduced apolipoprotein AI (apoAI) protein levels. To determine how cytokine-mediated insulin resistance suppresses apoAI gene expression, we investigated the effect of tumor necrosis factor alpha (TNF alpha) and interleukin-1beta (IL-1beta) on apoAI protein, mRNA, and transcriptional activity in the human hepatoma cell line HepG2. ApoAI secretion was suppressed in a dose-dependent manner in HepG2 cells treated with both cytokines. ApoAI protein levels were 2892+/-22.0, 2263+/-117, 2458+/-25.0, 3401+/-152, 2333+/-248, 1520+/-41.5 and 956.0+/-11.0 arbitrary units (AU) in cells treated with 0, 0.3, 1.0, 3.0, 10, 30, and 100 ng/ml TNF alpha, achieving statistical significance in the 30 and 100 ng/ml range (P<0.0009). ApoAI protein levels were 4055+/-360, 3697+/-101, 3347+/-327, 1561+/-33.0, 1581+/-182, 810.0+/-59.5, and 1766+/-717 AU in cells treated with similar doses of IL-1beta, achieving statistical significance within the range of 3-100 ng/ml (P<0.02). ApoAI mRNA levels were suppressed 50.8% in HepG2 cells treated with 30 ng/ml TNF alpha for 24 h (P<0.05), and remained suppressed for up to 96 h. Similarly, treatment of cells with 30 ng/ml IL-1beta for 24 h, resulted in 42.9% reduction in apoAI mRNA levels (P<0.05) and remained suppressed for up to 96 h. In order to determine if the effect of TNF alpha and IL-1beta occurs at the transcriptional level, HepG2 cells were transfected with a chloramphenicol acetyltransferase (CAT) reporter gene plasmid containing the full-length apoAI promoter, and after 24 h, treated with TNF alpha (30 ng/ml), IL-1beta (30 ng/ml), or both cytokines. CAT activity was suppressed by both cytokines (24.0+/-1.9% acetylation in control cells vs. 5.6+/-1.2% (P<0.0004), 10.2+/-1.5% (P<0.0006), and 3.9+/-0.9% acetylation (P<0.0002) in cells treated with TNF alpha, IL-1beta, and the combination of both cytokines, respectively) suggesting that cytokine-mediated suppression occurs at the transcriptional level. Using a series of apoAI deletion constructs, the cytokine response element was mapped between nucleotides -325 and -186 (relative to the transcriptional start site). This region contains a previously identified and characterized cis-element, site A, which binds several different transcription factors. Finally, electrophoretic mobility shift assays (EMSA) showed that TNF alpha treatment of HepG2 cells is associated with reduced nuclear factor binding to site A. These studies suggest that inflammatory cytokines down-regulate apoAI expression at least partly through inhibition of binding of the nuclear factors to site A of the apoAI promoter.

An audit on public awareness of depression symptoms in Jordan.

OBJECTIVES: Depression is a common mental health disorder. The aim of this study is to determine the level of public awareness regarding this illness, its symptoms, associated factors, available forms of treatment, and the attitude towards depressed people. METHODS: A self administered questionnaire was filled in by approximately 5000 individuals selected from various regions of Jordan. RESULTS: The majority of participants thought that depression is a treatable condition that can affect patient at any age, and may be controlled by the will power. Loss of interest in things and presence of negative feelings were the most commonly recognized symptoms of depression, while, unemployment and poverty were found to be the most recognized risk factors for depression. In addition, most participants considered support from family and friends (93.6%) as well as exercise (80.4%) to be the best available forms of depression treatment. Respondents found it acceptable to work, make friends with, or marry depressed individuals. The first choice persons for seeking help by most participants were family members and friends (49.8%). CONCLUSION: Collectively, the level of awareness of depression was acceptable. However, further efforts are necessary to establish public educational programs related to depression in order to raise awareness regarding the disease.