Self-medication practice among the general public in Jordan: a cross-sectional study.

Objectives: The phenomenon of self-medication is a noteworthy public health concern that is increasingly prevalent on a global level, particularly in developing nations. This study aims to explore the prevalence of self-medication of over-the-counter (OTC) medications among the general public in Jordan. Materials and methods: This cross-sectional online survey study was conducted in Jordan between November and December 2022. An online questionnaire link was distributed to the study participants through social media platforms (Facebook, WhatsApp, and Instagram). The questionnaire tool for this study was adapted from a previously developed questionnaire by Tesfamariam et al. The questionnaire tool comprised four sections that examined participants' demographic characteristics, knowledge of OTC self-medication, attitudes toward OTC self-medication, and associated practices. Binary logistic regression analysis was used to identify predictors of OTC self-medication practice. Results: A total of 1,218 individuals participated in this study. More than half of the study participants (56.9%) confirmed that they were currently using or had in the past year used medication(s) not prescribed by a healthcare specialist. Participants' agreement level on statements that reflected a positive attitude toward self-medication practice ranged between 13.1 and 33.0%. The statement most commonly agreed with was that 'OTC medications are safe but I would seek a physician's advice before using them' (57.7%). Individuals aged 36-40 years and 51 years and over, those who were married or divorced, those who were employed, and those who had chronic diseases were more likely to practice self-medication compared to others (p < 0.05). Conclusion: The current study findings suggest a significant lack of awareness among the general population in Jordan regarding the expected efficacy of OTC medications. A restricted level of agreement was observed among the participants concerning the behavior of self-medication.

Determinants of poor health-related quality of life among outpatients with rheumatoid arthritis in Jordan.

OBJECTIVE: The purpose of this study was to assess the health-related quality of life (HRQOL) and investigate the variables contributing to reduced HRQOL in patients with rheumatoid arthritis. METHODS: The present cross-sectional study was conducted on patients diagnosed with rheumatoid arthritis at two teaching hospitals in Jordan using a convenience sampling technique. The participants were interviewed face-to-face during the scheduled appointment at the outpatient rheumatology clinic. The HRQOL was evaluated by the validated EuroQol-5 Dimension (EQ-5D) questionnaire, which included the EQ-5D utility index that evaluated HRQOL in terms of 5 domains, including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, and the EQ-5D visual analogue scale (EQ-5DVAS), which evaluated HRQOL on a vertical scale ranging from 0 (worst imaginable health) to 100 (best imaginable health). The validated short version of the 19-item Compliance Questionnaire for Rheumatology (CQR-5) was used to evaluate medication adherence. The Clinical Disease Activity Index (CDAI) was used to assess disease activity among the study participants. A stepwise quantile regression model (q = 0.5) was conducted to explore the factors associated with the EQ-5DUtility Index and EQ-5DVAS scores. RESULTS: In total, 261 patients with RA participated in the study. The median (interquartile range) of the EQ-5DUtility Index and EQ-VAS scores was 0.552 (0.006-0.726) and 0.506 (0.233-0.690), respectively. Regression analysis results demonstrated that medication non-adherence (regression coefficient (ß) = -0.348, P<0.01), not performing regular physical activity (ß = -0.209, P<0.01), and higher disease activity as measured by the CDAI score (ß = -0.015, P<0.01) were significant predictors of a lower EQ-5DUtility Index score. In addition, medication non-adherence (ß = -0.199, P<0.01), not performing regular physical activity (ß = -0.117, P<0.01), increased body mass index (BMI) (ß = -0.009, P<0.01), and higher CDAI score (ß = -0.009, P<0.01) were significant predictors of low EQ-5DVAS score. CONCLUSIONS: Patients with RA experienced significantly impaired HRQOL. Medication non-adherence, not performing regular physical activity, increased body weight, and increased disease activity were identified as determinants of poor HRQOL among patients with RA in the present study. Treating physicians should encourage regular physical activity, maintaining a healthy body weight, and controlling disease activity to improve HRQOL in patients with RA.

Education and socioeconomic status as predictors of refugee mental health: insights from a study of Jordan-based Syrian refugee sample.

Background: The Syrian civil war is considered as the greatest humanitarian crisis in modern history, which has resulted in a major refugee crisis. A significant concern is the high prevalence of mental disorders such as depression, anxiety, and post-traumatic stress disorder (PTSD) among Syrian refugees. While the focus of most refugee mental health research has been pre-migration trauma, post-migration challenges and stressors, which can also be significant determinants of mental health, are often ignored. The purpose of this study was to assess mental health of Syrian refugees as compared to local Jordanians, and to examine sociodemographic factors and perceived stressors that are associated with mental distress among participants. Methods: This was a cross sectional study conducted in northern region of Jordan among Syrian refugee and Jordanian adults. We used the validated Arabic version of Afghan Symptoms Checklist (ASC) to assess mental distress among participants. Results: A total of 929 subjects (43% Syrian refugees, 56% females) participated in this study. Disparities in education, monthly income, and health insurance were significant between Syrian refugees and Jordanians, p < 0.001. The mean score in ASC was significantly higher among Syrian refugees, particularly among refugee females (mean ASC score ± standard deviation: Syrian refugee females: 58.22 ± 1.13; Syrian refugee males: 45.31 ± 1.28; Jordanian females: 51.06 ± 0.91; Jordanian males: 46.45 ± 1.08, p = 0.002). Multivariable linear regression showed that the estimated difference in the mean of ASC score between males and females is 7.42 (p < 0.001), and the estimated mean difference between Syrian refugees and Jordanians is 2.76 (p = 0.019). Interestingly, the estimated mean of ASC scores for individuals with high education level is decreased by 4.18 as compared to individuals with lower education level (high school or less), p < 0.001. Conclusion: Education level was highly predictable of mental distress of Syrian refugees, particularly female refugees. Enhancing higher educational opportunities is proposed for improving socioeconomic status of refugees which might serve as a buffering strategy for mental distress among this vulnerable population.

OPTIMISING THE CLINICAL ASSESSMENT OF CHILDHOOD AND ADOLESCENT OBESITY IN JORDAN.

Clinical practice guidelines aim to facilitate early diagnosis, implement early treatment and minimise gaps in care regardless of physician expertise or level of seniority. Consensus guidelines must be adapted to meet local and regional differences allowing for optimum benefit with what is available in terms of diagnostics and treatments. Childhood and adolescent obesity are no exception to this. In this survey we aim to understand practice variation and gaps to better advocate for a regional and local care plan for obesity care in the young. METHODS: A questionnaire was conducted between July 2024 and August 2024, aimed at healthcare professionals of all medical specialties. It consisted of 104 questions. RESULTS: Family medicine consultants treat most obese youth in Jordan. Several gaps were identified in the assessment and care of patients, including but not limited to psychosocial effects of obesity and efficient multidisciplinary teamwork. CONCLUSION: Clear consensus guidelines are necessary to tackle childhood and adolescent obesity in Jordan.

How to optimise creative art therapy to foster the mental health of refugee adolescents? A Delphi study protocol.

OBJECTIVE: This study aims to identify the most recommended components of creative art therapy (CAT) to improve the mental health of refugee adolescents. DESIGN: A three-round Delphi design is proposed. The first round will include semi-structured interviews with a panel of 12 CAT professionals worldwide and 12 refugee adolescents aged 10-24 in Jordan with a history of participating in creative arts interventions. The hybrid approach of coding and thematic analysis will be conducted to develop statements on recommended CAT components from the interview narratives. In the second round, the same and newly enrolled 24 professionals and 24 refugee adolescents will be asked to rate the statements according to their importance, propose new statements, and add comments. A similar procedure will be followed in the third round, where panellists will rate new and old statements after perusing the feedback from the second round. MAIN OUTCOME MEASURE: A statement will gain consensus and indicate essential components when rated 'essential' or 'very important' by > = 80% of panellists. Very important components are those with the same ratings by 60-79.9% of panellists. RESULTS: A list of essential and very important components, perspectives and suggestions will be provided to guide practice and intervention development.

Shaping the future: perspectives on the Integration of Artificial Intelligence in health profession education: a multi-country survey.

BACKGROUND: Artificial intelligence (AI) is transforming health profession education (HPE) through personalized learning technologies. HPE students must also learn about AI to understand its impact on healthcare delivery. We examined HPE students' AI-related knowledge and attitudes, and perceived challenges in integrating AI in HPE. METHODS: This cross-sectional included medical, nursing, physiotherapy, and clinical nutrition students from four public universities in Jordan, the Kingdom of Saudi Arabia (KSA), the United Arab Emirates (UAE), and Egypt. Data were collected between February and October 2023 via an online survey that covered five main domains: benefits of AI in healthcare, negative impact on patient trust, negative impact on the future of healthcare professionals, inclusion of AI in HPE curricula, and challenges hindering integration of AI in HPE. RESULTS: Of 642 participants, 66.4% reported low AI knowledge levels. The UAE had the largest proportion of students with low knowledge (72.7%). The majority (54.4%) of participants had learned about AI outside their curriculum, mainly through social media (66%). Overall, 51.2% expressed positive attitudes toward AI, with Egypt showing the largest proportion of positive attitudes (59.1%). Although most participants viewed AI in healthcare positively (91%), significant variations were observed in other domains. The majority (77.6%) supported integrating AI in HPE, especially in Egypt (82.3%). A perceived negative impact of AI on patient trust was expressed by 43.5% of participants, particularly in Egypt (54.7%). Only 18.1% of participants were concerned about the impact of AI on future healthcare professionals, with the largest proportion from Egypt (33.0%). Some participants (34.4%) perceived AI integration as challenging, notably in the UAE (47.6%). Common barriers included lack of expert training (53%), awareness (50%), and interest in AI (41%). CONCLUSION: This study clarified key considerations when integrating AI in HPE. Enhancing students' awareness and fostering innovation in an AI-driven medical landscape are crucial for effectively incorporating AI in HPE curricula.

Impact of pain on functional status and quality of life in Jordanian women with breast cancer.

BACKGROUND: Currently, breast cancer is the most prevalent type of cancer affecting women, and the number of newly diagnosed cases continues to increase both in Jordan and globally. Upon receiving a cancer diagnosis, the suffering experienced by patients intensifies as they grapple with the debilitating side effects that hinder their ability to carry out routine activities. PURPOSE: This study aims to assess the impact of cancer pain on functional status and quality of life (QOL) among Jordanian women with breast cancer. METHODS: A descriptive cross-sectional design and structured interviews were conducted in the Oncology Unit at Al-Bashir Hospital with a sample of 150 eligible Jordanian women with breast cancer who provided data on pain and functional status, and QOL using four Arabic questionnaires (brief pain inventory, functional status SF-12 questionnaire, and quality of life index) to measure pain and functional status and QOL, descriptive statistics, Pearson correlation, and regression statistical test were utilized to analyze the study data. RESULTS: A Significant positive correlation (r = 0.342) was found between cancer pain and functional status interference, a significant negative correlation (r = -0.134) between quality of life and functional status interference, and a significant negative correlation (r = -0.211) between pain and quality of life. Patients with higher intensity of cancer pain are more likely to experience low functional status and poor QOL. CONCLUSION: Breast cancer patients experience alterations in their quality of life as a result of cancer-related pain, which has a detrimental impact on their ability to carry out daily activities and disrupts their functional abilities. Healthcare providers must take these alterations into account and effectively handle them. Understanding the relationship between cancer pain and breast cancer can aid nurses in managing symptoms and providing holistic care, ultimately improving the quality of life.

The Mediation Roles of Coping Modalities on the Relationship Between Stress and Quality of Life Among Jordanian Nurses.

Nurses are at the frontline, dealing with people's most immense healthcare needs in stressful and demanding work environments. Consequently, it is essential to thoroughly examine how various coping mechanisms might affect the relationship between stress and quality of life (QOL). This study aimed to examine the mediation effect of both problem-focused coping (PFC) and emotion-focused coping (EFC) mechanisms on mitigating the effect of stress on the QOL among Jordanian nurses. A multisite cross-sectional descriptive correlational design was used in this study. An online survey was completed by 203 nurses using a convenience sampling technique between October 2023 and January 2024. The study included nurses working in different Jordanian healthcare sectors including governmental, private, and university-affiliated hospitals. Several measures were used to collect data, including questionnaires on sociodemographics, QOL, coping, and stress. Two models were hypothesized for this study. The two models were analyzed using Andrew Hayes Process Macro Model 4 for testing the mediation effects. Additionally, descriptive and correlational analyses were run prior to the main analysis. The results showed that coping significantly mediated the relationship between stress and QOL with variations between PFC and EFC. In conclusion, psychological distress symptoms were common among Jordanian nurses; psychological distress, coping, and QOL are correlating variables. Nurses' stress levels and coping modalities can predict QOL with a superior effect of PFC compared with EFC. Strategies should be put in place to improve effective coping to improve nurses' QOL. The results of this study have important implications for nursing education, practice, future research, and policy.

Knowledge toward quality improvement among Jordanian nursing students: A cross-sectional study.

BACKGROUND: Nurses have a critical role in quality improvement (QI) and patient safety. This necessitates gaining knowledge and mastering QI abilities to lead and participate in QI programs in clinical practice. AIM: To assess undergraduate nursing students' knowledge about QI, and experience of patient safety situation; and examine the relationship between obtaining information on healthcare quality and knowledge about QI in Jordan. DESIGN: A descriptive cross-sectional correlational design was used. The study engaged undergraduate nursing students from two Jordanian universities (Public and private universities). A convenient sample of 147 nursing undergraduate students from universities. METHODS: Data were collected using paper-based self-reported questionnaires. The Quality Improvement Knowledge, Skills, and Attitudes (QulSKA) survey and the Healthcare Professional Patient Safety Assessment Curriculum Survey (HPPSACS) were used to assess knowledge about QI and patient safety. RESULTS: Out of 152 students, 147 completed the study. Overall, QI knowledge was moderate (mean score 57.7). Students from the private university scored significantly higher than public university students. Regarding patient safety, 74.8% of students observed medical errors in clinical areas. However, only 57.1% of the students disclosed a medical error to a faculty member. Also, the results showed a significant positive correlation between knowledge level about QI and obtaining information about QI, quality in healthcare, and patient safety from sources other than the undergraduate nursing program at universities (p≤.001). CONCLUSIONS: This study suggests a potential gap in QI education. Integrating QI concepts into nursing curricula may be necessary to prepare future nurses for healthcare quality improvement.

Proposed framework for medication delivery system in the Jordanian public health sector.

BACKGROUND: In Jordan, the confluence of traffic congestion and overcrowding in public hospitals poses a significant challenge for patients to collect their medications timely. This challenge was further intensified during the COVID-19 pandemic. Recognizing this issue, the Ministry of Health (MOH) and Electronic Health Solutions (EHS) intend to establish a Medication Delivery System (MDS), designed to provide patients with home delivery of medications and ensure proper treatment. This paper outlines a comprehensive framework to guide requirements engineers in devising an effective MDS framework, with a focus on expediting the development and testing processes and mitigating the risks associated with constructing such a system. METHOD: The proposed methodology entails a robust, structured approach to requirements development for an MDS that integrates an electronic health record system, billing system, pharmacy application, the patient-oriented My Hakeem app, and a delivery tracking system. The requirements elicitation and analysis processes were undertaken by a multidisciplinary committee from MOH and EHS teams, ensuring a diverse understanding of stakeholder needs and expectations. The requirement specifications were meticulously documented via a data dictionary, unified modeling language (UML), and context diagrams. The quality and accuracy of the requirements were verified through an extensive validation process, involving thorough review by various EHS teams and the MOH committee. RESULTS: The MDS was implemented across numerous MOH facilities within a timeline that was a third of the original projection, leveraging the same level of resources and expertise. Post the requirements development phase, there were no changes requested by any stakeholders, indicating a high level of requirement accuracy and satisfaction. CONCLUSION: The study illustrates that our proposed methodology significantly results in a comprehensive, well-documented, and validated set of requirements, which streamlines the development and testing phases of the project and effectively eliminates requirement errors at an early stage of the requirements development process.

Genetic Polymorphisms of Immunity Regulatory Genes and Alopecia Areata Susceptibility in Jordanian Patients.

Background and Objectives: Alopecia areata (AA) is a tissue-specific immune-mediated disorder that affects hair follicles and the nail apparatus. Due to the collapse of hair follicle immune privilege in AA, hair loss ranges in severity from small, localized patches on the scalp to the loss of entire body hair. Although AA is of uncertain etiology, the disease has a common genetic basis with a number of other autoimmune diseases. Materials and Methods: To identify candidate genes that confer susceptibility to AA in the Jordanian population and further understand the disease background, we performed DNA genotyping using case-control samples of 152 patients and 150 healthy subjects. Results: While no significant result was observed in the ten single-nucleotide polymorphisms (SNPs), CLEC4D rs4304840 variants showed significant associations with AA development within our cohort (p = 0.02). The strongest associations were for the codominant and recessive forms of rs4304840 (p = 0.023 and p = 0.0061, respectively). Conclusions: These findings suggest that CLEC4D gene variants may contribute to AA pathogenesis among Jordanians. Further advanced genetic analysis and functional investigations are required to elucidate the genetic basis of the disease.

Cancer Care in Resource-Limited Countries: Jordan as an Example.

Jordan, a lower- to middle-income country, is relatively small, but with rapidly growing population and a challenged economy. Cancer is a growing health care problem and currently ranked second, after cardiovascular diseases, as a cause of death. Jordan's national cancer registry continues to suffer from problems mostly related to long lag time in reporting, absence of outcome data, and accurate staging. The number of new patients with cancer diagnosed in Jordan is increasing at an expected, none disturbing rate, fueled by population growth, improving life expectancy, changing population structure that hosts more older population, high rate of obesity, smoking, and lack of adequate exercise. However, age-standardized rate for cancer incidence is significantly lower than Western societies, yet, mortality rate is higher. Despite efforts, cancer is still diagnosed at more advanced stages and at younger age. The Jordan breast cancer program represents a great example of opportunistic screening that led to significant downstaging of breast cancer. Efforts to evaluate the feasibility of screening programs for colorectal and lung cancers are underway. Tremendous efforts resulted in the execution of the largest clinical cancer genetics program in the region that helps identify patients and at-risk relatives for hereditary cancers. Low-resourced countries, including Jordan, will not be able to keep up with the rapidly increasing cost of cancer care. A better access to clinical trials and moving cancer care to ambulatory settings should offset some of this cost. A cancer control program that addresses all issues of cancer care from screening and early detection, through active cost-effective treatment that assures wider access to palliative care, hospice, and survivorship programs under an expanded universal health coverage, is an urgent national health priority.

SAPPNet: students' academic performance prediction during COVID-19 using neural network.

A variety of reasons have made it more difficult for educators and tutors to anticipate students' performance. Numerous researchers have used various predictive models to identify students who may be at-risk of dropping out early. Additionally, these methods were used to forecast final semester grades based on various datasets. However, these prediction models still fall short of meeting educational management requirements. In this paper, we propose the deep learning (DL) based model named students academic performance prediction network (SAPPNet) to predict the students' grades. We consider the questionnaire-based Jordan University dataset which contains demographic information, usage of digital tools before and after COVID-19, sleep times before and after COVID-19, social interaction, psychological state, and academic performance. SAPPNet consists of spatial convolution modules which are designed to extract spatial dependencies includes categorical and numerical attributes that represent static features (gender, level/year, age, digital tools used before and after COVID-19, psychological condition using prolonged e-learning tools) and temporal module for temporal dependencies involves sequences that capture changes before and after COVID-19. Additionally, we also try to implement classical machine learning (ML) models including support vector machine, k nearest neighbor, decision tree, and random forest, and DL models named artificial neural network, convolutional neural network, long short-term memory, and students learning prediction network. Simulation results show that SAPPNet achieved the best performance compared to state-of-the-art methods, with an accuracy, precision, recall, and an F1-score of 93 % . The proposed model with spatial and temporal modules improves the prediction performance, and it implies new aspect of the educational dataset.

Determinants of maternal adherence to child vaccination in jordan: A cross-sectional study.

In the past few years, a significant decline in vaccination coverage has been noted, leading to measles outbreaks. Mothers' adherence or reluctance to undergo childhood immunization is a major contributing factor to a substantial population of children who remain unvaccinated or inadequately vaccinated. This study aimed to investigate adherence to children's vaccination by investigating mothers' personal and contextual factors in addition to knowledge and attitudes scores. A cross-sectional analytical design was employed, and data were collected from a sample of 533 mothers in Jordan between May and July 2023. The statistical analysis included descriptive analysis, t-test, ANOVA, and Pearson r correlation. The results demonstrated that adherence to vaccination was associated with several factors, including knowledge score (r = 0.33, p < 0.01), the ability to access and understand health information (r = 0.16, p < 0.01), income level (F = 11.88, p < 0.01), education level (F = 5.71, p < 0.01), employment (t = 2.41, p < 0.05), and working in a medical field (t = 4.5, p < 0.01). Scheffe post hoc analysis was performed to evaluate adherence outcomes according to the different categories of education and income levels. Mothers' adherence to vaccination needs improvement, with special attention given to contributing factors. Strategies should be developed to target mothers with low incomes and educational levels and limited ability to access and understand health information to enhance maternal knowledge and eventually adherence to children's vaccination.

The point prevalence of stress incontinence among young adult Jordanian women based on activity levels.

BACKGROUND: Stress Urinary incontinence (SUI) is a common condition among women of all ages. The point prevalence of SUI among young adult Jordanian women is less explored. OBJECTIVES: To examine the point prevalence of SUI among this sample based on activity level, and whether the affected women have shared their complaints with healthcare providers and/or received education related to UI. METHODS: This was a cross-sectional survey-based study. Participants with diseases that affect the control of micturition were excluded. The International Consultation on Incontinence Questionnaire-UI Short-Form was used to calculate the point prevalence of UI. The Tegner activity scale was used to classify participants based on their physical activity levels. The participants reported whether they shared their complaints with a healthcare provider or received education about this health problem. RESULTS: Five hundred women (median age = 20 years, BMI = 22) participated (118 competitive athletes, 192 recreational, and 190 sedentary). The overall point prevalence of SUI was 14% (n = 61). A chi-square test of independence showed a significant difference in the point prevalence of SUI between women with different activity levels, χ2 (12) = 12.07, p < 0.01. The point prevalence of SUI among competitive athletes, recreational women, and sedentary women was 21%, 8%, and 11%, respectively. None of those with SUI have shared their complaints with healthcare providers or received education related to SUI. CONCLUSION: SUI is prevalent among young adult Jordanian women, with the highest prevalence observed in those engaged in competitive athletic activities. The affected women refrain from disclosing their SUI-related concerns to healthcare practitioners and lack sufficient knowledge about this health issue.

Psychological well-being, food insecurity, academic performance and other risk factors in a sample of university students in Jordan during COVID-19.

This research validated an Arabic version of the Psychological General Well-being Index-Short version (PGWB-S) and examined the relationship between perceived psychological well-being, and food insecurity, academic achievement, and other risk factors in a sample of university students in Amman, Jordan, during COVID-19. A cross-sectional study was conducted in two phases. Phase 1 translated and validated the Arabic copy of the PGWB-S in 122 students from the University of Jordan. In Phase 2, 414 students completed the demographic questionnaire, Arabic versions of the PGWB-S, the Ryff Psychological Well-being Scale, and the Individual Food Insecurity Experience Scale. The participants had a mean PGWB-S score of 15.82 ± 0.34, and 41.3% had a mean score below 15. Psychological well-being was better in students younger than 21 and/or who had a GPA ≥3.0, were of normal weight or overweight, physically inactive, and food secure, did not drink coffee or smoke, as well as in those whose neighbourhood contained grocery stores and/or public transportation (P < 0.05). In conclusion, during the pandemic, perceived mental well-being was moderate in a Jordanian sample of university students. Perceived psychological well-being was also positively associated with food security and academic performance. These findings suggest that improving food security and academic achievement may contribute to enhanced psychological well-being among university students. Therefore, higher education institutions with the help of the government are encouraged to facilitate the provision of mental health care services to students, mainly post the coronavirus, which according to our knowledge is limited.

Mortality of patients with sepsis in intensive care units at tertiary hospitals in Jordan: Prospective cohort study.

The aim of this study was to describe the 30-day mortality rate of adult patients with sepsis and septic shock in 6 intensive care units of 2 tertiary hospitals in Jordan. A prospective cohort design was used. Patients with sepsis and septic shock admitted to the medical and surgical intensive care units at 2 tertiary hospitals were followed up during the period between February 2022 and June 2022 (N = 148). Data were analyzed using SPSS, version 23. Moreover, descriptive statistics, chi-square, and binary logistic regression were used. Notably, 52.7% of patients with sepsis and septic shock died within 30 days of diagnosis of sepsis and septic shock. Sequential Organ Failure Assessment score and the history of having solid tumors significantly predicted the 30-day mortality rate. Moreover, 43 (29.0%) patients with sepsis and septic shock had positive blood cultures, and 46 (31.0%) had positive urine cultures. Patients with sepsis and septic shock have a notable mortality rate that can be predicted from total Sequential Organ Failure Assessment scores and from the history of having solid tumors. Early assessment and initiation of treatment for sepsis essentially would reduce the likelihood of progression of sepsis to septic shock and would reduce associated patients' mortality.

Effect of stressors during COVID-19 lockdown on malnutrition and health-risk behaviors among Jordanian college students: A cross-sectional study.

A stressful condition such as the emergence of the coronavirus and its related lockdown measures might trigger alterations in college students' behaviors. This cross-sectional study aimed to identify the changes in college students' dietary and lifestyle behaviors during the lockdown and the effect of lockdown-related stressors on health-risk behaviors. A web-based survey was conducted among undergraduate college students in Jordan. Weight and height were reported by the students. The students' dietary and lifestyle behaviors and their changes during 1 month of the countrywide lockdown were assessed. The Perceived Stress Scale-4 was utilized to assess stress levels. Results indicated that 77.2% of the students reported weight changes. Notably, 45.9% increased their intake of unhealthy food, while and 38% opted for healthier food choices. Most students experienced alterations in physical activity (80.0%), screen time (86.2%), smoking, and sleep patterns (85.4%), with a higher tendency toward adopting health-risk behaviors. Perceptions of curfew-related stress were associated with distance learning-related stress (OR = 2.73, CI: 1.08-6.90, P = .034), and a greater change in physical activity (OR = 3.59, CI: 1.36-9.48, P = .010). Additionally, weight changes were associated with perception of other types of stressors (OR = 3.39, CI: 1.39-8.28, P = .007). Overall, there was a considerable increase in malnutrition and health-risk behaviors among students during the lockdown. Understanding students' responses to these stressful conditions and the role of stress in driving behavioral changes are crucial for developing interventions that enhance college students' adaptation to such changes and maintaining healthy dietary and lifestyle behaviors in the future.

Molecular characterization of Giardia duodenalis, Cryptosporidium spp., and Entamoeba spp. infecting domestic and feral/stray cats in Jordan.

This study aimed to carry out a molecular screening for the presence of Giardia, Cryptosporidium, and/or Entamoeba in the feces of pet and stray/feral cats in Jordan. G. duodenalis was found in 27.9% (95% CI, 23.2-32.9) of the 348 sampled cats overall; E. histolytica was found in only 0.6% (95% CI, 0.1-2.1) of the cats, while none of the sampled cats had Cryptosporidium infections. The infection rate of G. duodenalis among indoor cats (32.3%) did not differ significantly from that among outdoor cats (24.1%). There were significantly more infections (p = 0.0004) geographically in the cold semiarid areas (67%) than in the cold desert areas (24%). Multilocus sequence typing analysis of amplicons based on the bg, tpi, and gdh genes revealed that the majority of G. duodenalis infections were zoonotic assemblage B (65.9%; 64 of 97 positive samples); followed by feline-specific assemblage F (18.5%, 18/97); cattle-specific assemblage E (5.2%, 5/97); and then assemblage C that was shared with canids (1.0%; 1/97). Within Giardia isolates, a substitution mutation (A/G) was found at position 297 of the complete protein coding sequence (cds) of tpi-assemblage B, which may represent a new spreading mutation within this gene among the cat population in Jordan. The results of the present study suggest that close human-cat interactions could play a role in zoonotic transmission of Giardia, but further research is needed to determine the possible contribution of cats to the transmission of other protozoa to humans.

The association between health literacy and quality of life of patients with type 2 diabetes mellitus: A cross-sectional study.

BACKGROUND: Health literacy-driven interventions in patients with type 2 diabetes have been found to play an important role in achieving glycemic control and enhancing diabetic self-management outcomes. The present study aimed to examine the role of health literacy as a predictor of quality of life among diabetic patients in Jordan. METHODS: This cross-sectional study enrolled 400 Type 2 diabetic patients visiting the endocrinology department at the outpatient clinic at Al Basheer Hospital in Amman, Jordan. The data were collected between 1st of August and 28th of December 2023, using the validated Jordanian Diabetic Health Literacy Questionnaire and the EuroQol-5D tool. A quantile regression analysis was conducted to explore the factors associated with health-related quality of life among the study participants. RESULT: This study included 68.8% females, with a median age of 58 (50-64) years. The median EQ5-D index score was 0.66 (0.41-0.78). Findings from regression analysis indicated as patients' age increased, their quality of life scores significantly decreased (-0.004, 95%CI (-0.006, -0.001), p = 0.002). Additionally, higher JDHLQ scores were significantly associated with higher EQ5-D scores (0.012, 95% CI (0.006-0.018), p<0.001). Moreover, patients with only an elementary education had significantly lower EQ5-D scores compared to those with a postgraduate education (-0.106, 95%CI (-0.190, -0.023), p = 0.013). CONCLUSION: The findings of the present study emphasize the importance of including health literacy assessments and interventions in the diabetes care plans of patients in Jordan.