The impact of international health worker migration and recruitment on health systems in source countries: Stakeholder perspectives from Colombia, Indonesia, and Jordan.

INTRODUCTION: To address domestic shortages, high-income countries are increasingly recruiting health workers from low- and middle-income countries. This practice is much debated. Proponents underline benefits of return migration and remittances. Critics point in particular to the risk of brain drain. Empirical evidence supporting either position is yet rare. This study contributes to filling this gap in knowledge by reporting high-level stakeholders' perspectives on health system impacts of international migration in general, and active recruitment of health workers in specific, in Colombia, Indonesia, and Jordan. METHOD: We used a multiple case study methodology, based on qualitative methods integrated with information available in the published literature. RESULTS: All respondents decried a lack of robust and detailed data as a serious challenge in ascertaining their perspectives on impacts of health worker migration. Stakeholders described current emigration levels as not substantially aggravating existing health workforce availability challenges. This is due to the fact that all three countries are faced with health worker unemployment grounded in unwillingness to work in rural areas and/or overproduction of certain cadres. Respondents, however, pleaded against targeting very experienced and specialised individuals. While observing little harm of health worker migration at present, stakeholders also noted few benefits such as brain gain, describing how various barriers to skill enhancement, return, and reintegration into the health system hamper in practice what may be possible in theory. CONCLUSION: Improved availability of data on health worker migration, including their potential return and reintegration into their country of origin's health system, is urgently necessary to understand and continuously monitor costs and benefits in dynamic national and international health labour markets. Our results imply that potential benefits of migration do not come into being automatically, but need in-country supportive policy and programming, such as favourable reintegration policies or programs targeting engagement of the diaspora.

Bosonic Representation of Matrices and Angular Momentum Probabilistic Representation of Cyclic States.

The Jordan-Schwinger map allows us to go from a matrix representation of any arbitrary Lie algebra to an oscillator (bosonic) representation. We show that any Lie algebra can be considered for this map by expressing the algebra generators in terms of the oscillator creation and annihilation operators acting in the Hilbert space of quantum oscillator states. Then, to describe quantum states in the probability representation of quantum oscillator states, we express their density operators in terms of conditional probability distributions (symplectic tomograms) or Husimi-like probability distributions. We illustrate this general scheme by examples of qubit states (spin-1/2 su(2)-group states) and even and odd Schrödinger cat states related to the other representation of su(2)-algebra (spin-j representation). The two-mode coherent-state superpositions associated with cyclic groups are studied, using the Jordan-Schwinger map. This map allows us to visualize and compare different properties of the mentioned states. For this, the su(2) coherent states for different angular momenta j are used to define a Husimi-like Q representation. Some properties of these states are explicitly presented for the cyclic groups C2 and C3. Also, their use in quantum information and computing is mentioned.

Shedding light on the Ophel biome: the trans-Tethyan phylogeography of the sulfide shrimp Tethysbaena (Peracarida: Thermosbaenacea) in the Levant.

Background: Tethysbaena are small peracarid crustaceans inhabiting extreme environments such as subterranean lakes and thermal springs, represented by endemic species found around the ancient Tethys, including the Mediterranean, Arabian Sea, Mid-East Atlantic, and the Caribbean Sea. Two Tethysbaena species are known from the Levant: T. relicta, found along the Dead Sea-Jordan Rift Valley, and T. ophelicola, found in the Ayyalon cave complex in the Israeli coastal plain, both belonging to the same species-group based on morphological cladistics. Along the biospeleological research of the Levantine subterranean fauna, three biogeographic hypotheses determining their origins were proposed: (1) Pliocenic transgression, (2) Mid-late Miocenic transgression, and (3) The Ophel Paradigm, according to which these are inhabitants of a chemosynthetic biome as old as the Cambrian. Methods: Tethysbaena specimens of the two Levantine species were collected from subterranean groundwaters. We used the mitochondrial cytochrome c oxidase subunit I (COI) gene and the nuclear ribosomal 28S (28S rRNA) gene to establish the phylogeny of the Levantine Tethysbaena species, and applied a molecular clock approach for inferring their divergence times. Results: Contrary to the morphological cladistic-based classification, we found that T. relicta shares an ancestor with Tethysbaena species from Oman and the Dominican Republic, whereas the circum-Mediterranean species (including T. ophelicola) share another ancestor. The mean age of the node linking T. relicta from the Dead Sea-Jordan Rift Valley and Tethysbaena from Oman was 20.13 MYA. The mean estimate for the divergence of T. ophelicola from the Mediterranean Tethysbaena clade dated to 9.46 MYA. Conclusions: Our results indicate a two-stage colonization of Tethysbaena in the Levant: a late Oligocene transgression, through a marine gulf extending from the Arabian Sea, leading to the colonization of T. relicta in the Dead Sea-Jordan Rift Valley, whereas T. ophelicola, originating from the Mesogean ancestor, inhabited anchialine caves in the coastal plain of Israel during the Mid-Miocene.

Morphometrics of T11-L5 Vertebrae in Jordanian Population: CT Scan-Based Study / Morfometría de las Vértebras T11-L5 en una Población Jordana: Estudio Basado en Tomografía Computarizada

SUMMARY: The study will provide information on the morphometrics of the vertebrae, which can be used to guide clinicians on the appropriate size of transpedicular screws to use in spine interventions among the Jordanian population and for comparative studies with other races. A retrospective analysis of normal CT scans of the lumbar and thoracolumbar areas was done. Linear and angular measurements of 336 vertebrae were collected for 25 males and 23 females. The results were compared between right and left and between both sexes. The L5 has the longest AVBH and the shortest PVBH in both sexes, it also, had the shortest and widest pedicle in both males and females. ratio of the AVBH to PVBH showed progressive increase in both sexes from T11 to L5. Similarly, the VBW increased progressively from the top to the bottom in both sexes, but it was significantly different between both sexes. The L1 was the most cranially oriented vertebrae in males while the L2 showed the most cranial orientation in females. Both sexes L5 was the most caudally oriented vertebrae. This study provides a database for vertebral morphometrics in the Jordanian population, there are slight differences between the right and left side in the upper studied vertebrae (T11-L2) and some measurement showed significant differences between males and females. These findings need to be taken into consideration when inserting pedicle screws.

Este estudio proporciona información sobre la morfometría de las vértebras, la cual puede ser utilizada por los médicos oara determinar el tamaño adecuado de los tornillos transpediculares a utilizar en intervenciones de columna en la población jordana y para estudios comparativos con otras grupos. Se realizó un análisis retrospectivo de tomografías computarizadas normales de las áreas lumbar y toracolumbar. Se recogieron medidas lineales y angulares de 336 vértebras de 25 hombres y 23 mujeres. Los resultados se compararon entre vértebras derechas e izquierdas y entre ambos sexos. La L5 tiene el AVBH más largo y el PVBH más corto en ambos sexos, también tenía el pedículo más corto y más ancho tanto en hombres como en mujeres. La relación de AVBH a PVBH mostró un aumento progresivo en ambos sexos de T11 a L5. De manera similar, el VBW aumentó progresivamente de arriba hacia abajo en ambos sexos, pero fue significativamente diferente entre ambos sexos. La L1 fue la vértebra más orientada cranealmente en los hombres, mientras que la L2 mostró la orientación más craneal en las mujeres. En ambos sexos L5 fue la vértebra más orientada caudalmente. Este estudio proporciona una base de datos para la morfometría vertebral en la población jordana, donde existen ligeras diferencias entre el lado derecho e izquierdo en las vértebras superiores estudiadas (T11-L2). Algunas mediciones mostraron diferencias significativas entre hombres y mujeres. Estos hallazgos deben tenerse en cuenta al insertar tornillos pediculares.

Neutral lipid storage disease with myopathy and myotonia associated to pathogenic variants on PNPLA2 and CLCN1 genes: case report.

BACKGROUND: Neutral lipid storage disease with myopathy (NLSD-M) is an autosomal recessive disease that manifests itself around the 3rd to 4th decade with chronic myopathy predominantly proximal in the shoulder girdle. Clinical myotonia is uncommon. We will report a rare case of association of pathogenic variants on PNPLA2 and CLCN1 genes with a mixed phenotype of NLSD-M and a subclinical form of Thomsen's congenital myotonia. CASE PRESENTATION: We describe a patient with chronic proximal myopathy, subtle clinical myotonia and electrical myotonia on electromyography (EMG). Serum laboratory analysis disclosure hyperCKemia (CK 1280 mg/dL). A blood smear analysis showed Jordan's anomaly, a hallmark of NLSD-M. A genetic panel was collected using next-generation sequencing (NGS) technique, which identified two pathogenic variants on genes supporting two different diagnosis: NLSD-M and Thomsen congenital myotonia, whose association has not been previously described. CONCLUSIONS: Although uncommon, it is important to remember the possibility of association of pathogenic variants to explain a specific neuromuscular disease phenotype. The use of a range of complementary methods, including myopathy genetic panels, may be essential to diagnostic definition in such cases.

Evaluación de la calidad del agua de un río tropical usando índices bióticos, fisicoquímicos y de diversidad / Water quality assessment of a tropical stream using biotic, physicochemical and diversity indices

Introducción: Los ríos andinos en Colombia están fuertemente influenciados por diferentes actividades antrópicas. Los macroinvertebrados han sido utilizados para evaluar la calidad del agua en estos ecosistemas. Objetivo: Este estudio analizó el comportamiento de diferentes índices basados en macroinvertebrados para evaluar la calidad del agua del tramo medio-bajo del río Jordán en Jamundí (Colombia). Materiales y métodos: Se ubicaron tres estaciones de muestreo: E1 (1173 m.s.n.m.), E2 (1069 m.s.n.m.) y E3 (1019 m.s.n.m.). Se colectaron individuos en grava, bolos y macrófitas (n=15) y se midieron las concentraciones de variables fisicoquímicas y microbiológicas (n=15). Se evaluaron los índices de calidad de agua ICA-NSF y bióticos (BMWP/Univalle, ASPT y EPT) y los índices de Shannon-Weaver, Margalef y Simpson. Se realizó una correlación de Spearman entre las matrices de similitud biótica y ambiental. Resultados: El ICA-NSF presentó variaciones espacio temporales no significativas entre las estaciones de muestreo, con calidades de agua entre "regular" y "excelente". Los índices de diversidad mostraron que la equidad y riqueza son mayores en la estación E1. El BMWP/Univalle evidenció la influencia de las diferentes actividades sobre la subcuenca del río Jordán, clasificando la estación E1 como "Buena", E2 "Aceptable" y E3 "Dudosa". Las variables que mejor explicaron el patrón de diversidad fueron las asociadas a la contaminación orgánica (DBO5 y Coliformes totales). Conclusiones: Integralmente, los índices muestran que la mejor calidad del agua se presenta en la estación E1 donde la influencia de las actividades antrópicas es menor.

Introduction: Andean rivers in Colombia are heavily influenced along the drainage basin by various human activities. Aquatic macroinvertebrates have been used in different water environments to assess water quality in rivers. Objective: This study analyzed the behavior of different biotic indices to assess water quality of the lower middle section of the Jordan River in the department of Valle del Cauca, Colombia. Materials and methods: Sampling sites were situated at different altitudes as well with different anthropogenic influences. Physicochemical and microbiological parameters (n = 15) were measured, simultaneously with biological variables. Individuals were collected in gravel, pebbles and macrophytes (n = 15) using Surber nets (0.36 m2, 500 µm) a screen net (1.6 m2, 350 µm) and a D-net (0.9 m2, 500 µm). The water quality index (NSF ICA), biotic indices BMWP/Univalle, ASPT, EPT, and the Shannon-Weaver Equity index, Margalef Diversity index and Simpson's dominance index were evaluated to determine the macroinvertebrate assemblage through sampling sites. Spearman correlation between matrices of biotic and environmental similarity, using PRIMER® software was used to determine relationship between physicochemical variables and biodiversity. Results: The water quality index ICA-NSF showed spatio-temporal variations with water qualities between "regular" and "excellent". Diversity indices showed that equity and wealth are greater at site E1, where the influence of pollution is low. Biotic indices behaved variably, BMWP/Univalle index reflected more adequately the influence of human activities of the Jordan River sub-basin. Conclusions: The variables that best explained the pattern of diversity were those associated with organic pollution (BOD5 and total coliforms).

Seroprevalences of Toxoplasma gondii and Neospora caninum infections in Jordanian women who had a recent spontaneous abortion / Soroprevalências de infecções por Toxoplasma gondii e Neospora caninum em mulheres jordanianas que tiveram um aborto espontâneo recente

Abstract This cross-sectional study investigates Toxoplasma gondii and Neospora caninum among 445 recently spontaneously aborted (RSA) Jordanian women using ELISA and indirect fluorescent antibody (at a cut-off value of 1/200) tests, respectively. The type of hospital, age, cat and dog contacts, raw and barbecued meat and wild plant consumption, number of abortions, and stillbirths were tested as independent variables using univariate and multivariate logistic regression analyses. The true seroprevalences were 22.1% for T. gondii-IgG, 22.7% for N. caninum-IgG, 2.6% for T. gondii-IgM, 10.6% for N. caninum-IgM, 0% for T. gondii-IgG and IgM, 6.7% for N. caninum-IgG and IgM, and 4.6% and 0% for both parasite IgG and IgM, respectively. T. gondii-IgM-seropositivity was associated with the number of abortions with odds ratios (OR) of 2.4 and eating barbecued meat (OR = 0.12). N. caninum-IgG-seropositivity was associated with having a dog in the house (OR = 2.6), and with stillbirth (OR = 0.1). N. caninum-IgM was associated with visiting a private-hospital (OR = 2.7). RSA Jordanian women are equally exposed to both parasites with significantly (p < 0.05) higher seroprevalence of N. caninum-IgM compared to T. gondii-IgM suggestive of active infections among RSA women in Jordan.

Resumo Este é um estudo transversal, investigando Toxoplasma gondii e Neospora caninum entre 445 mulheres jordanianas recentemente abortadas espontaneamente (RSA), usando-se ELISA e testes de anticorpos fluorescentes indiretos (com valor de corte de 1/200), respectivamente. Tipo de hospital, idade, contato com o cão, consumo de carne, número de abortos foram testados como variáveis independentes, usando-se análises de regressão logística univariada e multivariada. As verdadeiras seroprevalências foram 22,1% para T. gondii-IgG; 22,7% para N. caninum-IgG; 2,6% para T. gondii-IgM; 10,6% para N. caninum-IgM, 0% para T. gondii-IgG e IgM, 6,7% para N. caninum-IgG e IgM, e 4,6% e 0% para ambos os parasitas IgG e IgM, respectivamente. A soropositividade para T. gondii-IgM foi associada ao número de abortos com "odds ratio" (OR) de 2,4 e ingestão de carne grelhada (OR = 0,12). A soropositividade para N. caninum-IgG foi associada à presença de cachorro em casa (OR = 2,6) e natimorto (OR = 0,1). N. caninum-IgM foi associada à visita a um hospital privado (OR = 2,7). Mulheres jordanianas com RSA estão igualmente expostas a ambos os parasitas com soroprevalência significativamente (p <0,05) maior de N. caninum-IgM, em comparação com T. gondii-IgM, sugestivo de infecções ativas entre mulheres com RSA na Jordânia.

Age, gender and climate associations with the seroprevalence of Neospora species infection in horses in Jordan / Idade, sexo e associações climáticas com a soroprevalência da infecção por Neospora em cavalos da Jordânia

A cross-sectional study was carried out on a sample of 379 horses to determine the seroprevalence of Neospora spp. in Jordan using the indirect fluorescent antibody test. Five variables, namely locality (n=10), climatic zone (n=4), age group (n=3), gender, and breed were tested as risk factors for Neospora–immunoglobulin (Ig)G seropositivity at four cutoff titers (1:50, 1:200, 1:400, and 1:800) using univariate and multivariate logistic regression analyses. A total of 122 (32%; 95% CI: 28, 37) sera samples had anti-Neospora–IgG at a cutoff titer of 1:50. Increased Neospora–IgG seropositivity was found in horses in three localities (Madaba, Zarka, and Petra) and was associated with the following variables: cool temperate climate; age >14 years; and female gender. Seropositivity was found among horses from Madaba at all cutoff titers, Zarka at titers >1:200, and Petra at titers <1:200. Cool temperate climate was associated with titers <1:400. Horses aged >14 years were found to be associated with seropositivity at titers ≥1:200. Female gender was associated with high seropositivity at >1:800.(AU)

Um estudo transversal foi realizado, na Jordânia, em uma amostra de 379 cavalos, para determinar a soroprevalência de Neospora spp., usando-se o teste de anticorpos fluorescentes indiretos. Cinco variáveis: localidade (n=10), zona climática (n=4), grupo etário (n=3), sexo e raça, foram testadas como fatores de risco para soropositividade para Neospora-imunoglobulina (Ig)G, considerando-se quatro pontos de corte (1:50, 1:200, 1:400 e 1:800) por meio de análises de regressão logística univariada e multivariada. Um total de 122 (32%; 95% CI: 28, 37) amostras de soros apresentaram anti-Neospora-IgG, utilizando-se como ponto de corte o título de 1:50. Cavalos de três localidades apresentaram aumento da soropositividade para Neospora-IgG (Madaba, Zarka e Petra) o que foi associado às seguintes variáveis: clima temperado fresco; idade >14 anos; e sexo feminino. Os cavalos de Madaba apresentaram soropositividade em todos os títulos utilizados como ponto de corte; os cavalos de Zarka em títulos >1:200; e os cavalos de Petra em títulos <1:200. O clima temperado fresco foi associado aos títulos <1:400. Cavalos com idade >14 anos estiveram associados à soropositividade nos títulos ≥1:200. O sexo feminino esteve associado à alta soropositividade nos títulos >1:800.(AU)

Age, gender and climate associations with the seroprevalence of Neospora species infection in horses in Jordan / Idade, sexo e associações climáticas com a soroprevalência da infecção por Neospora em cavalos da Jordânia

Abstract A cross-sectional study was carried out on a sample of 379 horses to determine the seroprevalence of Neospora spp. in Jordan using the indirect fluorescent antibody test. Five variables, namely locality (n=10), climatic zone (n=4), age group (n=3), gender, and breed were tested as risk factors for Neospora-immunoglobulin (Ig)G seropositivity at four cutoff titers (1:50, 1:200, 1:400, and 1:800) using univariate and multivariate logistic regression analyses. A total of 122 (32%; 95% CI: 28, 37) sera samples had anti-Neospora-IgG at a cutoff titer of 1:50. Increased Neospora-IgG seropositivity was found in horses in three localities (Madaba, Zarka, and Petra) and was associated with the following variables: cool temperate climate; age >14 years; and female gender. Seropositivity was found among horses from Madaba at all cutoff titers, Zarka at titers >1:200, and Petra at titers <1:200. Cool temperate climate was associated with titers <1:400. Horses aged >14 years were found to be associated with seropositivity at titers ≥1:200. Female gender was associated with high seropositivity at >1:800.

Resumo Um estudo transversal foi realizado, na Jordânia, em uma amostra de 379 cavalos, para determinar a soroprevalência de Neospora spp., usando-se o teste de anticorpos fluorescentes indiretos. Cinco variáveis: localidade (n=10), zona climática (n=4), grupo etário (n=3), sexo e raça, foram testadas como fatores de risco para soropositividade para Neospora-imunoglobulina (Ig)G, considerando-se quatro pontos de corte (1:50, 1:200, 1:400 e 1:800) por meio de análises de regressão logística univariada e multivariada. Um total de 122 (32%; 95% CI: 28, 37) amostras de soros apresentaram anti-Neospora-IgG, utilizando-se como ponto de corte o título de 1:50. Cavalos de três localidades apresentaram aumento da soropositividade para Neospora-IgG (Madaba, Zarka e Petra) o que foi associado às seguintes variáveis: clima temperado fresco; idade >14 anos; e sexo feminino. Os cavalos de Madaba apresentaram soropositividade em todos os títulos utilizados como ponto de corte; os cavalos de Zarka em títulos >1:200; e os cavalos de Petra em títulos <1:200. O clima temperado fresco foi associado aos títulos <1:400. Cavalos com idade >14 anos estiveram associados à soropositividade nos títulos ≥1:200. O sexo feminino esteve associado à alta soropositividade nos títulos >1:800.

"Ensamblaje" de macroinvertebrados acuáticos y su relación con variables fisicoquímicas en un río de montaña en Colombia

Debido a la influencia de diferentes actividades humanas, los ríos y su biodiversidad están bajo tensión. El objetivo de este estudio fue evaluar la diversidad de los macroinvertebrados acuáticos del río Jordán (Valle del Cauca) y su relación con variables fisicoquímicas. En el tramo evaluado (5 650 m) se realizan actividades de minería, captación de agua, ganadería, agricultura, recreación y ocupación ilegal del territorio. Se ubicó una estación de muestreo a 1 173 m.s.n.m. (E1), con vertimientos de agua residual doméstica. La segunda a 1 069 m (E2) se ubicó antes de la bocatoma del acueducto, y la tercera a 1 019 m (E3) después de la bocatoma. Se midieron las concentraciones de variables fisicoquímicas (n = 15). Los organismos fueron recolectados usando redes surber (0.36 m2, 500 µm), de pantalla (1.6 m2, 350 µm) y D-net (0.9 m2, 500 µm), evaluando la estructura del ensamblaje mediante categorías de abundancia. El ensamblaje de macroinvertebrados acuáticos se relacionó con las variables fisicoquímicas mediante un análisis de correspondencia canónica (ACC). Las variables fisicoquímicas mostraron que E3 fue la estación más contaminada. Se registraron 9 órdenes, 23 familias y 31 taxa. E3 presentó la menor riqueza y en E2 Rhagovelia fue dominante. El ACC mostró que las variables que mayor influencia tienen sobre el ensamblaje de macroinvertebrados son el oxígeno, la DBO5, los sólidos disueltos totales y la turbidez. Se concluye que la diversidad de macroinvertebrados acuáticos disminuye con el aumento de la materia orgánica posiblemente debido a los vertimientos residuales y disminución del caudal.

Because of the influence of different human activities, rivers and their associated biodiversity are under stress. The aim of this study was to evaluate the diversity of aquatic macroinvertebrates of the Jordán River and its relation to water quality. Mining, water harvesting, livestock, agriculture, recreation and illegal occupation of the territory; take place in the evaluated section (5 650 m). A sampling site was established at 1 173 m.a.s.l. (E1), here the river receives wastewater. The second, at 1 069 m.a.s.l. (E2) was set up before the intake of an aqueduct. And the third, at 1 019 m.a.s.l. (E3) after the inlet pipe. Concentrations of physicochemical variables (n = 15) were measured. Aquatic macroinvertebrates were collected in gravel, pebbles and macrophytes using Surber nets (0.36 m2, 500 µm), a screen net (1.6 m2, 350 µm) and a D-net (0.9 m2, 500 µm). The assemblage structure was assessed using abundance categories. The diversity of aquatic macroinvertebrate and physicochemical variables were associated using canonical correspondence analysis (CCA). The physicochemical variables showed that E3 was the most contaminated site. There were 9 orders, 23 families and 31 taxa. E3 had the lowest richness and in E2 Rhagovelia was dominant. The CCA showed that variables that have the greatest influence on the diversity of macroinvertebrates are oxygen, BOD5, Total Dissolved Solids (TDS) and turbidity. It is concluded that the diversity of macroinvertebrates decreases with increasing organic matter possibly due to sewage and flow decrease.

Impact of treated and untreated traumatic dental injuries on oral health-related quality of life among 12-year-old schoolchildren in Amman.

BACKGROUND/AIMS: Traumatic dental injuries (TDI) could have negative effects on the physical and psychosocial well-being of children. The aim of this study was to assess the prevalence of TDI and the impact of treated/untreated TDI on the quality of life of children among 12-year-old schoolchildren in Amman. MATERIALS AND METHODS: A cross-sectional study was conducted with 1652 schoolchildren aged 12 years enrolled in schools in Amman. OHRQol was assessed using the Arabic version of the Child Perceptions Questionnaire (CPQ11-14 ). Diagnosis of traumatic dental injury was based on Andreasen's classification. Dental caries and malocclusion were also recorded and analyzed along with social class. Statistical analysis included ANOVA and multiple logistic regression. RESULTS: The prevalence of TDI was 14.6%. There was a statistically significant impact of untreated TDI on all items of CPQ11-14 . When children with treated TDI were compared with those who had not suffered TDI, the only statistically significant impact was difficulty in chewing. Compared to children with treated TDI and those who had not suffered TDI, children with untreated TDI experienced significantly higher impacts related to the overall OHRQol, oral symptoms, the emotional and social well-being domains. Regarding functional limitation domain, children with untreated TDI experienced a significantly higher impact than children who had not suffered TDI, but children with treated TDI still had some limitations. CONCLUSIONS: The prevalence of TDI was 14.6%. Untreated TDI had a negative impact on OHRQol compared to absence of or treated TDI among 12-year-old schoolchildren in Amman.

Aetiology of Paediatric End-stage Renal Failure in Jordan: A Multicentre Study.

OBJECTIVE: The purpose of this study was to find out the aetiology of end-stage renal failure (ESRF) in children in Jordan. SUBJECTS AND METHODS: This was a multicentre retrospective study at five participating hospitals. Data collection included medical record review for age, gender, aetiology of ESRF, modality of renal replacement therapy (RRT) and outcome. End-stage renal failure was defined as estimated glomerular filtration rate < 15 mL/min/1.73m2. RESULTS: There were 275 children with ESRF: 131males and 144 females. The most common causes of ESRF in children were congenital anomalies of the kidney and urinary tract (CAKUT), 45.8%, heredofamilial disorders, 23.2% and glomerulopathies, 26.2%. Neurogenic bladder, reflux nephropathy and posterior urethral valve accounted for 16.8%, 12.7% and 4.0%, respectively. Amongst the heredofamilial disorders, primary oxalosis and cystic disease accounted for 8.0% and 7.2% of the aetiologies of ESRF, respectively. Focal segmental glomerulosclerosis was the most common histological type amongst the glomerulopathies (10.2%), followed by mesangiocapillary glomerulonephritis (4.7%) and chronic glomerulonephritis (3.0%). The aetiology was unknown in 4% of the cases. The modality of dialysis included isolated peritoneal dialysis (PD) in 30.9%, isolated haemodialysis (HD) in 49.1%, alternating peritoneal and haemodialysis in 9.1%, transplanted in 8.7% and conservative treatment in 1.8%. Death occurred in 57.3% of PD patients versus 34.4% in HD patients. CONCLUSIONS: This is the first report on the aetiology of ESRF in children in Jordan. The most common aetiologies of ESRF were CAKUT 45.8%, heredofamilial disorders 23.2% and glomerulopathies 22.9%.

High seroprevalence of Simkania negevensis in Jordan

The bacterium Simkania negevensis is a germ associated with respiratory diseases. This study aims at estimating the prevalence of Simkania in the Jordanian population. Serum samples from 664 Jordanian males and females, aged 2 to 86 years were collected. IgG and IgM Simkania-specific antibodies were detected using an indirect immunofluorescence test. Seropositivity titers for IgG and IgM were defined as 1:8 and 1:10, respectively. The overall prevalence of IgG antibody in all examined Jordanian nationals was 58.4%. IgG seropositivity was low in children under the age of 10 years (34.2%), and increased rapidly with age and ranged between 49.4% and 72%. Simkania-specific IgM was detected in 24.8% of subjects. IgM prevalence in children under 10 years was lowest (10.5%) and increased in older ages and remained above 20%. Overall detection rates of both IgG and IgM were significantly higher in females than males (60.7% vs. 54.5% for IgG and 26.7% vs. 21.7% for IgM). These data indicate that Simkania infection is highly prevalent in Jordan. The high level of seropositivity is most likely maintained by re-infections or chronic infections. Our data may serve as a basis to elucidate the pathogenesis of Simkania in Jordan.

High seroprevalence of Simkania negevensis in Jordan

The bacterium Simkania negevensis is a germ associated with respiratory diseases. This study aims at estimating the prevalence of Simkania in the Jordanian population. Serum samples from 664 Jordanian males and females, aged 2 to 86 years were collected. IgG and IgM Simkania-specific antibodies were detected using an indirect immunofluorescence test. Seropositivity titers for IgG and IgM were defined as 1:8 and 1:10, respectively. The overall prevalence of IgG antibody in all examined Jordanian nationals was 58.4%. IgG seropositivity was low in children under the age of 10 years (34.2%), and increased rapidly with age and ranged between 49.4% and 72%. Simkania-specific IgM was detected in 24.8% of subjects. IgM prevalence in children under 10 years was lowest (10.5%) and increased in older ages and remained above 20%. Overall detection rates of both IgG and IgM were significantly higher in females than males (60.7% vs. 54.5% for IgG and 26.7% vs. 21.7% for IgM). These data indicate that Simkania infection is highly prevalent in Jordan. The high level of seropositivity is most likely maintained by re-infections or chronic infections. Our data may serve as a basis to elucidate the pathogenesis of Simkania in Jordan.

High seroprevalence of Simkania negevensis in Jordan.

The bacterium Simkania negevensis is a germ associated with respiratory diseases. This study aims at estimating the prevalence of Simkania in the Jordanian population. Serum samples from 664 Jordanian males and females, aged 2 to 86 years were collected. IgG and IgM Simkania-specific antibodies were detected using an indirect immunofluorescence test. Seropositivity titers for IgG and IgM were defined as 1:8 and 1:10, respectively. The overall prevalence of IgG antibody in all examined Jordanian nationals was 58.4%. IgG seropositivity was low in children under the age of 10 years (34.2%), and increased rapidly with age and ranged between 49.4% and 72%. Simkania-specific IgM was detected in 24.8% of subjects. IgM prevalence in children under 10 years was lowest (10.5%) and increased in older ages and remained above 20%. Overall detection rates of both IgG and IgM were significantly higher in females than males (60.7% vs. 54.5% for IgG and 26.7% vs. 21.7% for IgM). These data indicate that Simkania infection is highly prevalent in Jordan. The high level of seropositivity is most likely maintained by re-infections or chronic infections. Our data may serve as a basis to elucidate the pathogenesis of Simkania in Jordan.

Variation in vertebral number and its morphological implication in Galaxias platei.

Variation in the vertebral number of the puyen grande Galaxias platei was examined for specimens from 22 localities that span the entire distribution range of the species (from 40° to 55° S). The mean vertebral number (NMW ) increases towards high latitudes, i.e. Jordan's rule is applicable to this species. Owing to the wide geographic variation of the species, not only in latitude but also in altitude, the most explicative variable for NMW was mean winter air temperature, showing negative dependence. Morphological data suggest that the increment in vertebral number lies in the pre-pelvic region of the trunk and in the caudal region, but not in the segment between pelvic-fin insertion and the origin of the anal fin. As these alterations in body shape have important consequences for hydrodynamics and swimming performance, vertebral number variation in G. platei also holds implications for both individual and population fitness.

Standards of teeth preparations for anterior resin bonded all-ceramic crowns in private dental practice in Jordan

OBJECTIVES: To investigate if general dental practitioners (GDPs) in private practice in Jordan follow universal guidelines for preparation of anterior teeth for resin bonded all-ceramic crowns (RBCs). MATERIAL AND METHODS: A sample (n=100) of laboratory models containing 208 tooth preparations for IPS Empress and In Ceram, featuring work from different GDPs, was obtained from 8 commercial dental laboratories. Aspects of preparations were quantified and compared with accepted criteria defined following a review of the literature and recommendations of the manufactures' guidelines. RESULTS: Subgingival margins on the buccal aspect were noticed in 36 percent of the preparations, 54 percent demonstrated overpreparation with a tendency to overprepare the teeth on the mesiodistal plane more than buccolingual plane. Twenty percent of samples presented a shoulder finish line while a chamfer margin design was noticed in 39 percent. Twenty-nine percent and 12 percent of samples had either a feathered or no clear margin design respectively. Incisal underpreparation was observed in 18 percent of dies of each type. Only 17 percent of all preparations were found to follow the recommended anatomical labial preparations while 29 percent of the RBC preparations were found to have the recommended axial convergence angle. In total, 43 percent of preparations were found to have the recommended depth of the finish line. CONCLUSIONS: It was found that relevant guidelines for RBC preparations were not being fully adhered to in private practice in Jordan.

Quality assurance and accreditation.

PIP: In 1996, the Joint Commission International (JCI), which is a partnership between the Joint Commission on Accreditation of Healthcare Organizations and Quality Healthcare Resources, Inc., became one of the contractors of the Quality Assurance Project (QAP). JCI recognizes the link between accreditation and quality, and uses a collaborative approach to help a country develop national quality standards that will improve patient care, satisfy patient-centered objectives, and serve the interest of all affected parties. The implementation of good standards provides support for the good performance of professionals, introduces new ideas for improvement, enhances the quality of patient care, reduces costs, increases efficiency, strengthens public confidence, improves management, and enhances the involvement of the medical staff. Such good standards are objective and measurable; achievable with current resources; adaptable to different institutions and cultures; and demonstrate autonomy, flexibility, and creativity. The QAP offers the opportunity to approach accreditation through research efforts, training programs, and regulatory processes. QAP work in the area of accreditation has been targeted for Zambia, where the goal is to provide equal access to cost-effective, quality health care; Jordan, where a consensus process for the development of standards, guidelines, and policies has been initiated; and Ecuador, where JCI has been asked to help plan an approach to the evaluation and monitoring of the health care delivery system.^ieng

GO-NGO collaboration in FP programs.

PIP: JOICFP has conducted the Seminar on Family Planning Administration for Senior Officers II regularly since 1967, providing training in family planning to 1151 participants in more than 70 countries over the period. 16 representatives from governmental (GO) and nongovernmental organizations (NGOs) from Bangladesh, Ghana, Indonesia, Jordan, Mexico, Nepal, the Philippines, and Tanzania attended the 1997 seminar, held in Japan from August 25 through September 12. It was the first time that one representative each of a GO and an NGO from each country attended the training course. GO-NGO collaboration was emphasized throughout the seminar with the goal of fostering better GO-NGO working relationships. Participants were provided with background on the promotion of family planning and maternal and child health (FP/MCH) in Japan from postwar times up to the present and the role played by GO-NGO collaboration in the success of these activities and the preventive healthcare movement in general. The other major theme of the event was the development of strategies to achieve the self-reliance of programs such as the community-based promotion of integrated programs. Excerpts are presented from interviews with 3 participants.^ieng

Effect of counselling on use-continuation of contraception. Highlights from an IPPF study.

PIP: A brief summary was provided of a report which examined the factors important in contraceptive choice and continuation. The study involved Guatemala, Trinidad and Tobago, Hong Kong, Jordan, Nepal, and Kenya between 1984 and 1987. The aim was to improve family planning services in efficiency and quality of programming. The findings indicated that continuation of use was related to women's personal motivation (desire for no more children or postponed pregnancy), obtaining the desired method, and knowing there was partner agreement on the chosen method. The implication for family planning programs was the inclusion of counseling and education for increasing motivation, provision of a variety of contraceptive methods, and inclusion of the male partner in decision making about contraceptives. On the basis of 5 questions asked of clients about perception of counseling, the results of the quantitative assessment indicated that a higher score on counseling was associated with a discontinuation. The suggestion was that counseling may be too extensive and force discussion issues with unwilling clients. Misunderstanding increasing anxiety levels of clients, rather than contributing to confidence in methods. Counseling should be reassuring and not scary regarding potential side effects. Sometimes more time is spent during counseling on nonrelevant issues to the client and less time on proper and consistent use of the chosen method. What is meant by proper and appropriate counseling needs to be further defined, and the impact on consistent and proper use of contraceptives needs to be indicated. Hypothesis testing should be conducted on the idea that it is quality of counseling, and not quantity, that is important for clients. Recommendations for family planning programs were: 1) the focus should be on essential information and discussions that help the client make an adequate choice and properly use the method chosen; 2) the available time should be a factor in the number of issues discussed; 3) the client's ability to understand and retain information should be a factor in determining the amount of information; and 4) service providers must be aware of differing needs and levels of knowledge of clients.^ieng