Disparities in Obstetric, Neonatal, and Birth Outcomes Among Syrian Women Refugees and Jordanian Women.

Objectives: To compare obstetric and neonatal characteristics and birth outcomes between Syrian refugees and native women in Jordan. Methods: We used the Jordan Stillbirths and Neonatal Deaths Surveillance System to extract sociodemographic and obstetric characteristics of the mothers and birth characteristics of newborns. Multivariate analysis was used to compare the characteristics of 26,139 Jordanian women (27,468 births) and 3,453 Syrian women refugees (3,638 births) who gave birth in five referral hospitals (May 2019 and December 2020). Results: The proportions of low birthweight (14.1% vs. 11.8%, p < 0.001) and small for gestational age (12.0% vs. 10.0%, p < 0.001) newborns were significantly higher for those born to Syrian women compared to those born to Jordanian women. The stillbirth rate (15.1 vs. 9.9 per 1,000 births, p = 0.003), the neonatal death rate (21.2 vs. 13.2 per 1,000 live births, p < 0.001), and perinatal death rate (21.2 vs. 13.2 per 1,000 births, p < 0.001) were significantly higher for the Syrian births. After adjusting for sociodemographic and obstetric characteristics of women, only perinatal death was statistically significantly higher among Syrian babies compared to Jordanian babies (OR = 1.3, 95% CI: 1.1-1.7, p = 0.035). Conclusion: Syrian refugee mothers had a significantly higher risk of adverse obstetric and neonatal outcomes including higher rate of perinatal death compared to Jordanian women.

Psychometric Properties of the Posttraumatic Stress Disorder Checklist among the Lebanese Population Exposed to the Beirut Explosion: A Cross-Sectional Study during the COVID-19 Pandemic.

Objective: This study was aimed at testing the psychometric properties of the posttraumatic stress disorder (PTSD) checklist for the Diagnostic Statistical Manual version 5 (DSM-5) (PCL-5) among the Lebanese population and at identifying the prevalence of PTSD. Design: A cross-sectional survey of PCL-5 among 950 Lebanese, using the online survey platform by Google Form, was conducted. Snowball recruitment was used to identify participants for the survey. Results: Face, content, construct, discriminant, and convergent validity had been accomplished through the survey. The reliability using Cronbach's alpha, composite, and average variance extracted was identified as superior. We also found that more than half of the participants (55.6%) scored 33 or above which is the cut-off score for a likely diagnosis of PTSD. Conclusion: The current study provides further support for the validity and reliability of the Arabic version of PCL-5 among non-Western populations. This supports using the checklist in the screening of probable PTSD.

Identifying psychosocial problems, needs, and coping mechanisms of adolescent Syrian refugees in Jordan.

Background: Refugees who have fled war zones are at a heightened risk of psychosocial problems that can impact their ability to function in day-to-day life and place a significant burden on the family structure. This study aimed to assess the psychosocial problems and needs and coping mechanisms of Adolescent Syrian refugees in Jordan. Methods: Between October and December 2018, we conducted a qualitative study using semi-structured interviews with a sample of key and individual informants. Our sample included 20 primary healthcare professionals, 20 schoolteachers, 20 Syrian parents, and 20 adolescents aged 12-17 years. All interviews were transcribed verbatim, and we utilized thematic analysis to group, categorize, and analyze the original Arabic language transcripts. To ensure thorough analysis, we adopted a bottom-up inductive approach that covered the six-phase iterative process proposed by Braun and Clarke. Results: The main psychosocial problems encountered by Syrian adolescents included stress, depression, loneliness, lack of a sense of security, isolation, aggressiveness, fear of war, and family disintegration. Almost all schoolteachers reported that they observed that Jordanian adolescents are more settled, self-confident, and financially stable relative to their Syrian peers. The Jordanian government and community were praised for their support, including education, recreational centers, health services, and awareness campaigns. Going to school, praying and reading the Holy Quran, listening to music, and talking to friends and engaging with them were reported as the main coping mechanisms. The majority of respondents said that more services are still needed for adolescents, including more places for entertainment, psychosocial support and psychological counseling, medical care, job creation, and providing health insurance. Conclusion: Syrian refugees are aware of the psychological aspects of their situation, but they are not always able to access clinic-based humanitarian assistance for mental health and psychosocial support. Stakeholders must interact with refugees to learn about their needs and develop services that are appropriate for their culture.

Medication Adherence and Its Influencing Factors among Patients with Heart Failure: A Cross Sectional Study.

Background and objectives: The chronic nature of heart failure requires long-lasting consumption of various medications. Despite the therapeutic benefits of heart failure medications, about 50% of patients with heart failure don't adequately adhere to their medications as prescribed globally. This study aimed to determine medication adherence levels among Jordanians with heart failure and its influencing factors. Materials and Methods: A cross-sectional study was conducted among 164 patients with heart failure attending cardiac clinics in the north of Jordan. The Medication Adherence Scale was used to measure medication adherence. Results: Overall, 33.5% of patients had high adherence, and 47% had partial to poor adherence. The proportion of patients with good to high adherence was significantly higher among patients younger than 60 years, having >high school level of education, being married, living with somebody, and having insurance. Conclusions: Patient-centered approach, targeting age, level of education, marital status, and health insurance coverage, should be developed using evidence-based guidelines to enhance adherence to medication and health outcomes in Jordanian patients with heart failure. The development and implementation of new and feasible strategies, particularly suited to Jordan's healthcare system capabilities, is important to improve medication adherence.

Development of a telemedicine group educational program for patients with heart failure: A delphi study.

Aims: Evidence regarding the most effective and feasible videoconferencing group educational program for patients with heart failure is still equivocal. This study aimed to reach consensus about the structure, acceptability, and feasibility of videoconferencing for people with heart failure in Jordan that improves access to healthcare and clinical outcomes. Methods: There were two Delphi survey studies of three rounds each. Delphi one survey involved 32 healthcare staff, experienced in heart failure clinical practice and telehealth, to obtain a consensus of opinion on a proposed group videoconferencing program for patients with heart failure. Delphi two involved seven staff of the information technology center, experienced in videoconferencing and using supporting applications, to obtain their consensus on the current capabilities of the healthcare system and patients about information technology. Descriptive statistics were used for each item to determine whether consensus was achieved or not. Items that received 80% disagreement or 80% agreement of participants were not presented for re-rating in the third round, while the items that scored varying degrees of agreement were presented for experts for re-rating. Results: In Delphi one a group of items reached consensus regarding structure, factors influencing, and effectiveness of the videoconferencing program. In Delphi two, the findings indicated that videoconferencing modality is applicable and feasible in Jordan. Conclusion: This is the first study that addresses the equivocal evidence for the design and implementation of heart failure videoconferencing programs. The framework of the current proposed program can be utilized as a guideline to test or develop a future videoconference program.

COVID-19 Fear and Anxiety among Patients with Chronic Heart Failure: A Cross Sectional Study.

Although the current management of COVID-19 is mainly focused on efficacious vaccine and infection control, the most common psychological reactions (such as fear and anxiety) associated with the COVID-19 pandemic have not been investigated and even neglected in patients with heart failure who are at greater risk for morbidity and mortality. We assessed COVID-19 related fear and anxiety among patients with heart failure and determined their associated factors. A cross sectional survey was conducted among 300 consecutive patients with heart failure during the period of March 2021−June 2021. Almost 50.7% of patients had fear of COVID-19 and 36.3% had coronavirus anxiety. Age > 55 was significantly associated with increased odds of fear (OR = 2.6) and anxiety (OR = 4.3). Patients with angina were more likely to have fear (OR = 3.0) and anxiety (OR = 2.2) and patients with chronic lung disease were more likely to have fear (OR = 3.0) and anxiety (OR = 3.3). Increased age, having angina, and having chronic lung disease were associated with increased odds of fear of COVID-19 and coronavirus anxiety. Psychological support needs to be integrated in patient care with special attention to physiological risk factors that are associated with COVID-19 comorbidities.

The effect of slow deep breathing relaxation exercise on pain levels during and post chest tube removal after coronary artery bypass graft surgery.

Objectives: This study aimed to evaluate the effectiveness of slow deep breathing relaxation exercise (SDBRE) in reducing patients' pain levels during chest tube removal (CTR) post coronary artery bypass grafting (CABG) surgery. Methods: In 2019, fifty post-CABG patients were conveniently selected from a cardiac intensive care unit in Jordan's major referral heart institute. The patients were randomly assigned to either an intervention group or a control group. A total of 25 patients were assigned into the experimental group who received slow deep breathing relaxation Exercise (SDBRE) alongside the conventional care before CTR. The remaining 25 patients constituted the control group (50%) that had CTR following conventional care. The Visual Analogue Scale (VAS) was used to measure the participants' pain levels during three phases: before CTR (Time 1), 5-min post CTR (Time 2), and 15-min post CTR (Time 2) to compare the intervention effect between the two groups. Results: The data analysis findings for the control and intervention group of patients showed that there was a statistically significant decline in their pain level across time for both groups (H = 32.71, P < 0.01; H = 47.23, P < 0.01) respectively. The intervention group had significantly lower pain levels than the control group at Time 2 (3.50 [1.20, 5.30] vs. 7.90 [7.00, 9.00], P < 0.01) and Time 3 (0.00 [0.00, 1.30] vs. 3.60 [2.40, 4.10] P < 0.01). Conclusions: Using SDBRE during CTR is an effective technique for reducing pain which can minimize the need for analgesics and their associated adverse effects.

Identifying Feasible Heart Failure Interventions Suitable for the Jordan Healthcare system: A Delphi Study.

Interventions and strategies should align with the context and capacity of the health system. Identifying the most feasible and appropriate heart failure interventions in Jordan will improve heart failure management and clinical outcomes. Therefore, this study aimed to derive consensus from clinicians (using the Delphi method) regarding the most feasible and appropriate heart failure interventions in Jordan. A two-round Delphi study involving seven clinicians and policy makers were conducted. The Delphi results found consensus for the feasibility of the educational materials, follow up phone call, cardiac rehabilitation, group session, and training courses for staff. The components that were not feasible were: multidisciplinary team, individual session, and telemonitoring devices. The present study demonstrates the importance of utilizing interventions tailored to patients' characteristics and aligned with the capacity of healthcare system.

Predictors of Effective Self-care Interventions Among Jordanians With Heart Failure.

Jordanians are more at risk for heart failure now than in years prior. However, there are few studies addressing heart failure self-care in Jordanians. Identifying predictors that promote heart failure self-care among Jordanian patients is crucial in providing comprehensive care. This study aimed to identify predictors of self-care behaviors among Jordanians with heart failure. A cross-sectional study with a convenience sample of 300 Jordanian patients was performed in an educational hospital in the north of Jordan. Differences in the level of self-care between selected sociodemographic and clinical variables were identified using univariate statistics, and multiple regression was used to adjust estimates for covariates. The predictors of self-care were insomnia (p ≤ .001) and marital status (p = .018). Identifying factors influencing self-care can assist with addressing the causes of insomnia to ensure effective treatment, providing patients with social support, and eventually promoting heart failure self-care.

Prevalence of Cigarettes and Waterpipe Smoking among Jordanians, Refugees, and Migrants in Jordan and Its Associated Factors: A Secondary Data Analysis.

Smoking is a major public health threat resulting in increased morbidity and mortality. This study aimed to determine the prevalence of current smoking among different adult populations in Jordan, including Jordanians, refugees, and migrants and determine the factors associated with smoking. A cross-sectional survey was conducted during the period of June-September 2021 among Jordanians, Syrian refugees (both urban and camp refugees), and migrants living in four governorates in Jordan, including Amman, Zarqa, Mafraq, and Irbid. The selection of the four governorates was based on criteria related to the presence of Syrian refugees in host communities. The highest prevalence of cigarette smoking was among urban Jordanians (51.1%), followed by non-camp refugees (46.7%), while the highest prevalence for waterpipe (43.2%) and dual smoking (28.7%) was among non-camp refugees. Being male, aged 25-45 years old, unemployed, and having less than a high school education, as well as being urban Jordanians, were all associated with higher odds of cigarette smoking. Being male, unemployed, and urban Jordanians or non-camp refugees were variables associated with higher odds of waterpipe smoking. The study findings indicate that the identification of smoking prevalence in Jordan and its associated factors, including gender, educational level, employment status, regional area, migration, and exposure to traumas, should be considered by healthcare providers to formulate smoking cessation programs tailored to their needs and ultimately reduce smoking prevalence.