Nursing students' attitudes towards mental illness: A multi-national comparison.

Accessible Summary What is known on the subject Health professionals, including nurses, are shown to have stigmatizing attitudes towards mental illness. For nursing students who are in their formative years of professional development, mental illness stigma can severely impact the care they provide. Little research has investigated multi-national comparisons of nursing students' attitudes towards mental illness. What this paper adds to existing knowledge This study shows that between countries, there were substantial differences amongst nursing students in stigmatizing attitudes towards mental illness. Cultural perspectives may explain some of these differences. What are the implications for practice Regardless of location, stigmatizing attitudes are present at varying levels. Each nation can take steps to reduce these by acknowledging the presence of stigmatizing attitudes amongst nurses, educating nurses regarding the negative impacts of stigma on patient outcomes, and decrease stigmatizing attitudes by facilitating opportunities for nurses (particularly student nurses) to have direct contact with people with lived experiences of mental illness. ABSTRACT: INTRODUCTION: Stigmatizing attitudes perpetuated by nursing professionals are a pervasive problem for people experiencing mental health issues. This global issue has detrimental consequences; inhibiting one's life chances and help-seeking behaviours. To date, few studies have compared nursing students' attitudes towards mental illness from a multi-national perspective. AIM: To compare undergraduate nursing students' attitudes towards mental illness across six countries: Australia, India, Jordan, Saudi Arabia, Taiwan and USA. METHOD: In a cross-sectional design, data were collected from undergraduate nursing students (N = 426) using the Social Distance Scale. A one-way analysis of variance was used to compare differences between countries. RESULTS: Nursing students' attitudes to mental illness differed between countries. Social Distance Scores were highest amongst nursing students from Jordan and Saudi Arabia. Students from Taiwan and India possessed moderate stigma scores. Social Distance Scores from the USA and Australia were lowest. DISCUSSION: Clear differences in stigmatizing attitudes emerged between countries; these are discussed in relation to possible cultural influences. IMPLICATIONS FOR PRACTICE: It is suggested that educating nurses, combined with direct contact with people with lived experiences of mental illness, can reduce stigmatizing attitudes regardless of country, location or educational institution.

Predictors of clinical performance in comprehensive care cases in undergraduate dentists.

INTRODUCTION: Achieving a high grade in the final-year comprehensive clinical care (CCC) course is not only important for the individual candidate but also to ensure competency of students as they transition from dental school into independent practice. Here, we aimed to identify predictors of success in the CCC that might prove useful to identify which, if any, students need focused intervention to improve their performance in the CCC. MATERIALS AND METHODS: This was a cross-sectional study of two consecutive cohorts (2017-2018 and 2018-2019) of final-year (Year six) dental students (n = 180 females and n = 150 males) attending [King Abdulaziz University], Saudi Arabia. Age, gender, cumulative GPA to the start of Year six and assessment results were tabulated and analysed as independent variables in binary logistic regression to identify predictors of the final case grade (≤69% or >70%). RESULTS: Year five GPA (OR 1.07, 95% CI 1.02-1.12; p = .004) and female gender (OR 2.21, 95% CI 1.12-4.36; p = .02) were significantly associated with an increased odds of achieving a final case grade >70%. In particular, female students were over twice as likely as male students to achieve a higher score in their final case assessment. DISCUSSION: This study suggests that gender may influence final performance in the CCC. The better performance of females in the final CCC course than their male counterparts suggests that there may be a narrowing or even reversal of the historical gender gap in dental school performance. CONCLUSIONS: Both cognitive (GPA) and other (i.e. gender) factors influence clinical dental performance. Further work is required to establish what instructional modifications are required to accommodate these gender differences in CCC courses to pave the way for personalised teaching approaches to optimise educational outcomes.

Ferrule effect and its importance in restorative dentistry: A literature Review.

This review aims to report the current literature on the status of ferrule in root-filled teeth, classify the different types of ferrules, highlight the biomechanical failures due to inadequate ferrule effect, and discuss the current restorative concepts according to the ferrule design principles.

An optimal deep learning framework for multi-type hemorrhagic lesions detection and quantification in head CT images for traumatic brain injury.

Traumatic Brain Injury (TBI) could lead to intracranial hemorrhage (ICH), which has now been identified as a major cause of death after trauma if it is not adequately diagnosed and properly treated within the first 24 hours. CT examination is widely preferred for urgent ICH diagnosis, which enables the fast identification and detection of ICH regions. However, the use of it requires the clinical interpretation by experts to identify the subtypes of ICH. Besides, it is unable to provide the details needed to conduct quantitative assessment, such as the volume and thickness of hemorrhagic lesions, which may have prognostic importance to the decision-making on emergency treatment. In this paper, an optimal deep learning framework is proposed to assist the quantitative assessment for ICH diagnosis and the accurate detection of different subtypes of ICH through head CT scan. Firstly, the format of raw input data is converted from 3D DICOM to NIfTI. Secondly, a pre-trained multi-class semantic segmentation model is applied to each slice of CT images, so as to obtain a precise 3D mask of the whole ICH region. Thirdly, a fine-tuned classification neural network is employed to extract the key features from the raw input data and identify the subtypes of ICH. Finally, a quantitative assessment algorithm is adopted to automatically measure both thickness and volume via the 3D shape mask combined with the output probabilities of the classification network. The results of our extensive experiments demonstrate the effectiveness of the proposed framework where the average accuracy of 96.21 percent is achieved for three types of hemorrhage. The capability of our optimal classification model to distinguish between different types of lesion plays a significant role in reducing the false-positive rate in the existing work. Furthermore, the results suggest that our automatic quantitative assessment algorithm is effective in providing clinically relevant quantification in terms of volume and thickness. It is more important than the qualitative assessment conducted through visual inspection to the decision-making on emergency surgical treatment.

Factors Influencing University Students' Acceptance to Undertake the COVID-19 Vaccine in Jordan.

Vaccines are effective measures that can mitigate the high burden of diseases. However, vaccine refusal poses serious challenges for achieving coverage for population immunity. With the availability of coronavirus disease-2019 (COVID-19) vaccines, limited information is available about the university students' acceptability and attitudes toward COVID-19 vaccines. This article reports study findings regarding factors that influence university students' decision of acceptability to the COVID-19 vaccine in Jordan. Results highlight the continued need for clear and consistent information about the vaccine by health care decision-makers and university administrations.

Acceptability of Covid-19 Vaccines and the Associated Factors That Influence the Decisions of Healthcare Workers in Jordan

@#Introduction: This study examined the factors that influence healthcare workers’ decisions regarding COVID-19 vaccines’ acceptability in Jordan. It also examined the impact of perceived risks of the vaccine on healthcare workers’ decisions toward accepting it. Methods: Jordanian healthcare workers in governmental and private hospitals completed a cross-sectional online questionnaire. Results: A total of 904 respondents (age, 35.04 ± 9.07 years) completed the survey. The results indicate that most participants (88.9%) were at risk of contracting COVID-19, and many (51.4%) were afraid of contracting it. Moreover, 48.3% of healthcare professionals stated they would get vaccinated against COVID-19. Furthermore, most of the healthcare workers in this study perceived the vaccine as neither safe nor effective and that it could have serious side effects. At last, in terms of afraid of contracting COVID-19, the gender of the healthcare worker and his/her profession was identified to be the most influential factors in the decision to accept the vaccine. Conclusion: Our findings emphasize the ongoing need for government agencies to provide accurate and consistent information that is essential in developing trust in the vaccination program. Nurses can lead campaigns to inform the healthcare workers about the efficacy, safety, and the impact of COVID-19 vaccine in limiting the spread of this pandemic among them. We recommend that nursing council lead these efforts to improve knowledge about the vaccine and its impact on the safety of the healthcare workers and the public.

Bone Quality in Chronic Kidney Disease Patients: Current Concepts and Future Directions - Part II.

BACKGROUND: Patients with chronic kidney disease (CKD) have an increased risk of osteoporotic fractures, which is due not only to low bone volume and mass but also poor microarchitecture and tissue quality. The pharmacological and nonpharmacological interventions detailed, herein, are potential approaches to improve bone health in CKD patients. Various medications build up bone mass but also affect bone tissue quality. Antiresorptive therapies strikingly reduce bone turnover; however, they can impair bone mineralization and negatively affect the ability to repair bone microdamage and cause an increase in bone brittleness. On the other hand, some osteoporosis therapies may cause a redistribution of bone structure that may improve bone strength without noticeable effect on BMD. This may explain why some drugs can affect fracture risk disproportionately to changes in BMD. SUMMARY: An accurate detection of the underlying bone abnormalities in CKD patients, including bone quantity and quality abnormalities, helps in institution of appropriate management strategies. Here in this part II, we are focusing on advancements in bone therapeutics that are anticipated to improve bone health and decrease mortality in CKD patients. KEY MESSAGES: Therapeutic interventions to improve bone health can potentially advance life span. Emphasis should be given to the impact of various therapeutic interventions on bone quality.

Bone Quality in CKD Patients: Current Concepts and Future Directions - Part I.

BACKGROUND: There is ample evidence that patients with CKD have an increased risk of osteoporotic fractures. Bone fragility is not only influenced by low bone volume and mass but also by poor microarchitecture and tissue quality. More emphasis has been given to the quantitative rather than qualitative assessment of bone health, both in general population and CKD patients. Although bone mineral density (BMD) is a very useful clinical tool in assessing bone strength, it may underestimate the fracture risk in CKD patients. Serum and urinary bone biomarkers have been found to be reflective of bone activities and predictive of fractures independently of BMD in CKD patients. Bone quality and fracture risk in CKD patients can be better assessed by utilizing new technologies such as trabecular bone score and high-resolution imaging studies. Additionally, invasive assessments such as bone histology and micro-indentation are useful counterparts in the evaluation of bone quality. SUMMARY: A precise diagnosis of the underlying skeletal abnormalities in CKD patients is crucial to prevent further bone loss and fractures. We must consider bone quantity and quality abnormalities for management of CKD patients. Here in this part I, we are focusing on advances in bone quality diagnostics that are expected to help in proper understanding of the bone health in CKD patients. KEY MESSAGES: Assessment of bone quality and quantity in CKD patients is essential. Both noninvasive and invasive techniques for the assessment of bone quality are available.

Comparison of fixed dose versus train-of-four titration of cisatracurium in acute respiratory distress syndrome.

PURPOSE: To compare the ventilatory and clinical outcomes associated with a fixed-dose cisatracurium infusion versus a titrated infusion strategy in patients with Acute Respiratory Distress Syndrome (ARDS). MATERIALS AND METHODS: Single-center, retrospective, cohort study in a medical ICU of a tertiary care academic medical center. Adult patients ≥18 years old with a continuous infusion of cisatracurium for ≥12 h for treatment of ARDS were included. The primary outcome was the PaO2 /FiO2 ratio assessed at 24 and 48 h following cisatracurium initiation. Secondary outcomes included amount of average dose of drug administered, 28-day ventilator-free days, LOS, and hospital mortality. RESULTS: 167 patients were included; median baseline PaO2/FiO2 was 97 (76-146), median SOFA score of 9 (7-11), and ICU mortality was 71/167 (43%). In a mixed-effects model, fixed dose and titrated cisatracurium associated with similar changes in PaO2/FiO2 assessed at 24 and 48 h (p = 0.316). Fixed-dose was associated with a >3-fold increase in drug exposure (average dose 6.4 (5.4-8.0) vs. 2.0 (1.5-2.8) mcg/kg/min; p < 0.001, respectively). No differences were observed in secondary clinical endpoints. CONCLUSION: Fixed-dose cisatracurium was associated with similar ventilatory and clinical outcomes compared to titrated strategy, yet it was associated with a 3-fold increase in dose administered.

Impact of Tooth Loss Position on Oral Health-Related Quality of Life in Adults Treated in the Community.

BACKGROUND: Tooth loss is known to have negative effects on both functional and psychological oral health-related quality of life (OHRQoL), but the impact of the position of the tooth loss (i.e. anterior or posterior) on the different psychosocial dimensions of OHRQoL has yet to be examined. Here, we examined how the position of lost teeth impacts the different dimensions of OHRQoL. METHODS: This was a cross-sectional epidemiological study of adults aged 18 years and older attending routine examinations at primary care dental centers in Jeddah, Kingdom of Saudi Arabia. Demographic information was collected, and OHRQoL was assessed using the Oral Health Impact Profile-14 (OHIP-14) (Arabic form). Differences in total and subdomain OHIP-14 scores between individuals without tooth loss and those with ≥1 anterior or posterior missing teeth were assessed using Student's t-test, and analysis of covariance was used to assess the association between the presence and absence of missing teeth in each compartment and total and subdomain OHIP-14 scores after controlling for age, gender, and income. RESULTS: The overall prevalence of tooth loss was 76%. In multivariate analysis controlling for age, gender, and income as covariates, anterior missing teeth were significantly associated with higher OHIP-14 total, physical pain, physical disability, psychological disability, and social disability scores, accounting for 6%-12% of the score variance. However, posterior missing teeth were only associated with total OHIP-14 and functional limitations domain scores, accounting for 6% and 7% of the variance, respectively. CONCLUSIONS: Here, we show for the first time the impact of the location of missing teeth on different OHRQoL dimensions. Anterior tooth loss has a wide-ranging impact on both physical and psychosocial functioning compared to posterior tooth loss, suggesting that anterior tooth restoration should be prioritized when treatment planning. The position of lost teeth must be considered in addition to the number of losses when examining the impact of tooth loss and its treatment on OHRQoL.

Development of a novel integrated educational relative-unit value system to assess dental students' clinical performance.

PURPOSE: The use of relative unit values (RUVs) to assess students' clinical productivity is common in dental education. However, there are large variations on how RUVs are defined, developed, validated, and reported across institutions. This study described the development of a novel educational RUV system. METHODS: A preparatory phase of literature review and methodological gap analysis, followed by initial conception, pilot testing, and a 2-round modified Delphi process were conducted. Panelists reviewed the procedure list, nomenclature, purpose of development, basis of calculation of RUVs, and the relative weights of different dental procedures. Also, their perception of the usefulness, fairness, and practicality of the system was assessed. Agreement was set at 80%. RESULTS: Eight published educational RUV systems were identified. These data guided the initial conception of the novel Integrated Educational RUVs (IERUVs). Five experts reviewed the system and it was piloted for a full educational cycle. Feedback from faculty and students was used to adjust over- or under-estimated RUVs, with deconstruction of multi-step procedures. Fifteen experts participated in the second Delphi round (71% response rate). Consensus was reached for 105 procedural RUVs. A total of 93% of the panelists agreed the system was useful, while 71% perceived it as fair and practical. CONCLUSION(S): Content validity of the new educational RUV was established. The system provides a promising tool for assessing dental students' clinical performance, as it provides a unified base unit to assess clinical productivity, clinical competence, and comprehensive care cases. Longitudinal evaluations in different contexts are needed to confirm IERUVs validity.

Lived Experience of Jordanian Parents Having a Child with Duchenne Muscular Dystrophy.

BACKGROUND: Duchenne muscular dystrophy (DMD) is a congenitally inherited disease characterized by progressive muscle damage and loss of function in children, which currently has no cure. Parents of children with DMD go through significant challenges when caring for a child with this condition. PURPOSE: The aim of this study was to explore the lived experience of Jordanian parents caring for a child with DMD. DESIGN AND METHODS: We utilized qualitative, descriptive, phenomenological design. Ten pairs of parents of children with DMD were interviewed at their homes from the southern region of Jordan. The Participant verbal as well as nonverbal cues were recorded during the interview. Data were analyzed using Colaizzi's 7-step method. RESULTS: Parents experienced psychosocial, emotional, and financial problems, which affected family dynamics and the quality of life. Themes emerged were face the new disease, caring for our child and handling the situation, staying in contact with the outside world, and career options and opportunities. CONCLUSIONS: Parents experienced feelings of stress and anxiety mixed with emotions of hopelessness. Parents relieved anxiety by sharing feelings with others, assuring themselves and accepting the reality of child's illness. PRACTICE IMPLICATIONS: It is necessary that parents undergo psychological counseling individually or by joining groups who had similar experiences. Follow-up by experts through the coping process. Addressing equity services in the country is necessary.

Determinants of Substance Use Among High School Students in Jordan.

BACKGROUND: Substance use is becoming a global health problem that concerns health professionals and decision makers. Studies showed that teens are at higher risk for substance use. PURPOSE: the purpose of this study was to examine the prediction power of the selected sociodemographic and psychological factors on substance use among high school students in Jordan. Specific aims were; 1) to explore substance use among high school students in Jordan, and 2) to examine the prediction power of sociodemographic and psychological factors on substance use among high school students in Jordan. METHODS: This is a predictive cross-sectional study where data was collected using self-administered questionnaires from a convenience sample of 1497 high school students in the central district of Jordan. RESULTS: Students who reported that they have never used stimulant agent were 91.5%, tranquilizer sedative 87.2%, hypnotic agent 85.8% and antidepressant agent 94.5%, while those never used nicotine were 81.7%. Coping efficacy (crude OR = 1.07, CI 95% = 1.03 - 1.12), psychological distress (crude OR = 1.07, CI 95% = 1.03 - 1.11), and perceived social support from family (crude OR = 1.20, CI 95% = 0.95 - 1.24) were significantly associated with substance use. While perceived social support from friends was not. CONCLUSION: High school students are at risk for the use of various forms of substances and mainly the over counter ones. Legitimate rules of screening and using substance prevention programs at high schools considering the psychological factors is a priority for school health professionals and policy makers.

Dimensions of Maxillary Lateral Incisor on the Esthetic Perception of Smile: A Comparative Study of Dental Professionals and the General Population.

AIM: To evaluate the effect of the differences in the dimensions of maxillary lateral incisor on the esthetic perception of smile among dental professionals and the general population. MATERIALS AND METHODS: Two sets of photographs where the maxillary incisor dimensions were modified using computer software (Adobe Photoshop) were created. In the first set, six images were included where the maxillary lateral incisor width was modified. The second set included five images where only the maxillary lateral incisor length was modified keeping the gingival margins same. Three groups of participants formed the sample. Hypodontia patients formed the first group, non-hypodontia patients formed the control group, while the dentists constituted to the third group. A total of 156 participants were recruited, 36 patients with radiographically confirmed hypodontia out of which 22 were female and 14 were male, 54 non-hypodontia "control" patients out of which 29 were female and 24 were male, and 66 dentists out of which 39 were female and 27 were male. Every participant had 15 seconds to view each photograph along with 30 seconds at the end for confirmation. RESULTS: The "most attractive smile" was the ones with 77% lateral incisor to central incisor width proportion according to 25.0% of the hypodontia group and 40.8% of the dentist's group, while only 4.2% of the control group agreed that it was the most attractive. However, the "least popular" was the 52% lateral incisor to central incisor width proportion according to 40.0% of patients who are hypodontic, 20.8% of participants from control group, and 49.0% of dentists. CONCLUSION: The golden proportion was not considered as the most attractive among all groups. The esthetic perceptions of the patients might not be same as that of the dentists. In general, reductions in the maxillary lateral incisor width were not all acceptable. CLINICAL SIGNIFICANCE: This study will help us understand the different perceptions of the patients and the dentists on esthetics, which would further help us in planning the treatment accordingly.

Barriers to nursing pain management in the emergency department: A qualitative study.

BACKGROUND: Although pain is a common complaint among patients presenting to emergency departments (EDs), there is a dearth of nursing literature about barriers to pain management. PURPOSE: The study aimed to uncover and understand barriers to pain management in the ED from the registered nurse (RN) perspective. METHODS: Semistructured interviews were conducted with 12 ED nurses in a Jordanian hospital. Data were collected throughout August 2016. RESULTS: Two broad categories with subcategories emerged. The first category describes the idea of types of patient, which included three particular groups. These were patients who are violent, patients with relatives who are, and patients with expectations of care that nurses view as unrealistic. The second category describes the taxing ED environment, with two subcategories of staff shortages and physician dominance of pain management. Nurses reported feeling as if they are the victims of external factors and perceived that barriers affected teamwork and led to distress which impairs pain management. CONCLUSIONS: The role of ED nurses in pain management is multifaceted. Therefore, implementing policies to overcome barriers such as violence among ED attenders and the perceived hostility of the ED environment through mandatory security systems, and continuing nursing education including for violence prevention may be beneficial.

Mental health nurses' perspective of workplace violence in Jordanian mental health hospitals.

PURPOSE: The purpose was to assess the mental health nurses' perspectives of workplace violence in mental health departments in Jordan. DESIGN AND METHODS: A cross-sectional correlation study was utilized to address the study's purposes. Data were collected using self-reported questionnaires from nurses working in governmental mental health departments in Jordan. FINDINGS: The findings indicated that 80% of the respondents were victims of at least one violent act in the last 2 years. Verbal abuse was the most indicated type of violence. Patients were considered the main source of violence. PRACTICE IMPLICATIONS: Policies and legislations addressing workplace violence should be implemented, and nurses should be trained on using such policies. Hospital managers should create a safe work environment by enforcing effective security measures and maintaining adequate staffing.

Prevalence of Health-risk Behaviors among Government Schools' Students in Jordan.

BACKGROUND: Adolescence is a developmental stage associated with many behavioural fluctuations and health risks behaviours. In this study, various health risk behaviours among Government school students in Jordan were assessed. METHODS: This cross-sectional descriptive study recruited 1256 students from 20 secondary schools all over the country. Students completed the Global School-based Student Health Survey (GSHS, 2009-2012). The study was conducted in the period between Feb 2016 and Aug 2016. Chi-square (x2) was used to examine differences among the demographic variables. RESULTS: Students scored low in eating breakfast, eating fruit, vegetables, and milk products. However, students scored moderately in hand and mouth hygiene. Students showed minimal incidences of physical attack and physical fight. Although suicidal attempts were not significantly reported, complaining from worries, feeling of sadness and hopelessness were moderately scored. The majority of physical activities were reported from walking or riding bicycles. However, three hours per day was the average of time spent on sitting activities. Students scored lowest in school absenteeism and the majority described their classmates as kind and helpful. Parental control on students' home activities was regarded. CONCLUSION: In comparison with 2004 and 2007 statistics, students revealed improvements in physical activity, and reduced physical attacks and injuries. Future researchers are encouraged to discover factors associated with these changes.

Validating the psychiatric nurses methods of coping questionnaire: Arabic version.

BACKGROUND: The aim of the study was to undertake a psychometric analysis of the Psychiatric Nurses Methods of Coping Questionnaire (PNMCQ) - Arabic version when used to measure coping skills in psychiatric nurses in Jordan. METHOD: A descriptive, cross-sectional design was adopted in this study. A demographic questionnaire and the 35-item PNMCQ -Arabic were the measures used to collect data. RESULT: The PNMCQ demonstrated valid and reliable values when administered to psychiatric nurses in Jordan after it had been submitted to factor analysis. CONCLUSION: The development of PNMCQ: Arabic Version adequately measures coping skills in psychiatric nurses from a culturally appropriate context. Use of the tool can determine coping skills in psychiatric nurses with the view to positive staff development. Strategies identified based on results of the PNMCQ could ultimately result in better nurse retention and patient outcomes.

TRADITIONAL PRACTICES ADOPTED BY JORDANIAN MOTHERS WHEN CARING FOR THEIR INFANTS IN RURAL AREAS.

BACKGROUND: Traditional practices are commonly present within the Jordanian society, especailly those concerned with infant's care. Some of these practices might be harmful and thus health professioanls are required to substitute these practices with safe and healthy ones. The goal of this study is to determine the traditional practices adopted by Jordanian mothers when caring for their infants in rural areas. MATERIALS AND METHODS: A descriptive study design using qualitative method was utilized in this study. A Purposive sample of 30 mothers was recruited from four rural regions in outskirts of Amman the capital city of Jordan. RESULTS: Mothers had traditional infant's care practices pertinent to bathing of babies, including the salting, swaddling, care of the umbilical cord and jaundice. CONCLUSION: Traditional practices are still common in Jordan; some of these behaviors can cause health risks. While health consequences of some of the traditional practices are still not clear, health professianls, especially nurses, are required to intervene by changing policies and education.