Investigating medical students' satisfaction towards video-based learning versus face-to-face lectures: a Jordanian tertiary teaching hospital experience.

PURPOSE: We aimed to evaluate the disparity between video-based learning and lecture-based learning on Jordanian medical students' satisfaction. METHODS: We conducted this cross-sectional study using a web-based questionnaire adapted from Student Evaluation of Educational Quality survey. Using convenience sampling, medical students studying at the University of Jordan and Jordan University Hospital were recruited. Participants in either clinical or basic-science years that have completed the entire survey were included in the final analysis. RESULTS: We surveyed a total 487 participants among which male to female ratio was 1.19:1. Participants perceived greater benefit in terms of learning, instructor enthusiasm, content organization, breadth of teaching, and quality and number of assignments when using video-based learning (all p<0.01). In contrast, face-to-face learning was associated with significantly higher benefits in terms of group interactions (p<0.01) and capacity for rapport building (p<0.01). There was no significant difference in perceived examination performance between the two learning modalities (p=0.11). CONCLUSION: Video-based learning is the preferred learning modality among Jordanian medical students. Despite its dominance across multiple domains, it should be implemented as an adjunct to traditional classroom teaching for it is vital in the development of good communication skills and building rapport in medical students.

Workplace Violence against Health Care Providers in Emergency Departments of Public Hospitals in Jordan: A Cross-Sectional Study.

Workplace violence (WPV) against healthcare providers is a serious problem that carries health, safety, and legal consequences. Healthcare providers working in emergency departments (ED) are more susceptible to WPV compared to other healthcare settings. This study aimed to assess the prevalence of physical and verbal violence against ED physicians and nurses in public hospitals in Amman, Jordan, and to explore the relationship between WPV and the socio-demographic characteristics of the participants. A quantitative descriptive cross-sectional study design was used to assess physical and verbal violence against ED physicians and nurses. A self-administered questionnaire was completed by 67 physicians and 96 nurses from three public hospitals in Amman. In the past year, 33% and 53% of the participants experienced physical and verbal violence, respectively. Compared to their female counterparts, males were more frequently physically (43.7% vs. 2.3%, p-value < 0.001) and verbally (61.3% vs. 29.5%, p-value < 0.001) abused. The main perpetrators of physical and verbal violence were the patients' relatives. Out of 53 physical and 86 verbal abuse incidents, only 15 cases (10.8%) were followed up with legal persecution. In conclusion, there is a widespread occurrence of physical and verbal violence against ED physicians and nurses in the public sector hospitals in Jordan. A collaborative effort by all stakeholders should be instituted to ensure the safety of the physicians and nurses and to improve the quality of the healthcare provided.

Depression rates and health-seeking behavior in primary care: Andersen model of health- care utilization.

Depression imposes a tremendous burden on the health-care systems. Many patients prefer informal (family & friends) over formal mental health services (MHS) provided by professionals. We aimed to investigate the prevalence of depression among primary care patients and to examine the factors predicting seeking MHS using the Andersen Health Care Utilization Model. We interviewed 300 primary care patients in Jordan. The mean age was 39.85 ± 14.45, and 80% were women. 35.7% had depression, and 28.7% had significant depression impairing daily function. The most commonly reported source of help was family members and less than one-third had the intention to seek formal MHS. The predisposing-factors domain was the only predictive of seeking MHS in depression and suicide, whereas the 'enabling' and 'need' domains were not. Knowledge, stigma and life satisfaction were predictive of seeking formal MHS. Raising awareness and empowering doctors to screen for depression is needed as less than a third would seek formal MHS.

Smartphone ophthalmoscopy versus slit-lamp biomicroscopy for optic nerve head evaluation: A digital apparatus into medical education.

OBJECTIVE: Th aim of this study is to explore the diagnostic accuracy of smartphone-based D-EYE ophthalmoscopy in the diagnosis of optic nerve head (ONH) abnormalities and screening for glaucoma. METHODS: This is a prospective clinical-based validation study performed on 90 patients recruited from a tertiary teaching hospital. Patients underwent dilated fundus examination by slit-lamp and smartphone-based D-EYE fundoscopy operated by two experienced ophthalmologists. RESULTS: The diagnostic accuracy of smartphone-based D-EYE ophthalmoscopy of normal vertical cup-to-disc ratio (VCDR) was acceptable (sensitivity 85.8%-96.4%; specificity 51.4%-96.4%). The D-EYE would often underestimate VCDR values as mean VCDR was significantly lower among overall and glaucoma cohorts (all p-value <0.001) for D-EYE in comparison with slit-lamp. In terms of ONH abnormalities, the D-EYE adequately demonstrated high sensitivity in the identification of only margins-related abnormalities (sensitivity 92.5%-96.6%). Overall, the diagnostic accuracy and agreement between expert ophthalmologists using the D-EYE and the reference slit-lamp examination were significantly poor. CONCLUSION: We demonstrated that the D-EYE is a highly specific tool for VCDR within the normal range but not in patients with glaucoma. Despite being an easy and portable tool to measure VCDR, it is limited in terms of diagnosing ONH and blood vessel abnormalities.

An incidental migrating intra-spinal bullet: the silent victim of celebratory gunfire.

BACKGROUND: Incidentally found intra-spinal bullets are extremely rare, and have never been reported in the literature. The aim of this study is to report a rare case of an asymptomatic migrating intra-spinal bullet, emphasizing the role of cultural context in history taking, and describing its surgical retrieval technique. CASE PRESENTATION: We discuss a case of a 10-years old boy with an incidentally discovered intra-spinal bullet opposite to the L5 vertebral level, who presented 3 months after the suspected initial insult. Following its migration to the L3/L4 level intraoperatively, the bullet was forced to spontaneously return to its preoperative position by reverse Trendelenburg Position, Valsalva maneuver and Intrathecal saline infusion, thus avoiding extending the previously performed laminectomy. CONCLUSION: The authors remind the readers that history is the cornerstone of the clinical practice, even in the most obscure cases. Many convoluted intra-operative situations could be resolved by utilizing basic anatomical and physiological principles.

Predictors of adherence with home quarantine during COVID-19 crisis: the case of health belief model.

Although Jordan has applied lockdown in response to COVID-19 pandemic, many people were not adherent to the quarantine. We aimed to examine the attitudes of the Jordanians and how these attitudes can predict their adherence using the health belief model (HBM). A cross-sectional study of 5057 participants using an internet-based questionnaire was conducted during lockdown. Multivariable ordinal regression analyses were used to estimate predictors of adherence to home quarantine. Overall, 646 (12.8%), 2078 (41.2%), and 2317 (46%) of participants showed poor, intermediate, and strict adherence, respectively. Of the HBM constructs, seriousness (ß= 0.116, 95% CI 0.027 to 0.205), benefits (ß= 0.056, 95% CI 0.002 to 0.110) and barriers (ß= -0.025, 95% CI -0.035 to -0.015) were significant predictors. We identified income insecurity (ß= -0.096, 95% CI -0.144 to -0.046), social withdrawal (ß= -0.062, 95% CI -0.121 to -0.004), religious concerns (ß= -0.149, 95% CI -0.202 to -0.096) and health consequences (ß= 0.065, 95% CI 0.011 to 0.11) as barriers. Governmental instructions were the only predictive external cue (ß= 0.055, 95% CI 0.004 to 0.014). Our findings suggest that a high number of Jordanians are adherent with the quarantine, demonstrating the ability of governmental policies in tackling potential barriers.

Qualitative Assessment of Early Adverse Effects of Pfizer-BioNTech and Sinopharm COVID-19 Vaccines by Telephone Interviews.

Vaccines are considered the best approach for countering the COVID-19 pandemic. In this study, we compared early side effects associated with vaccination with the Sinopharm and Pfizer-BioNTech COVID-19 vaccines. Participants of this observational cohort were interviewed based on semi-structured telephone interviews, with enquiries about side effects that developed after vaccination with each dose of these vaccines. Overall, 1004 participants were enrolled, of which 51.1% received Sinopharm vaccine and 48.9% received the Pfizer-BioNTech vaccine. After the first dose, 46.3% of participants had an adverse reaction, with injection site pain most commonly being reported (33.2%). Participants who received the Pfizer-BioNTech vaccine had significantly higher frequencies of all types of adverse reactions (p < 0.01), with no significant differences in the duration of adverse reactions between the two vaccines. Regarding the second dose, 48.6% of participants had adverse reactions, with injection site pain being most commonly reported (29%). Those who received the Pfizer vaccine reported higher frequencies of all adverse reactions (p < 0.01). However, a longer duration of adverse reactions was seen among Sinopharm vaccine recipients as compared to Pfizer-BioNTech vaccine recipients (p = 0.01). In conclusion, early adverse effects are reported following all types of vaccines but these are more likely to be encountered following the administration of new-generation vaccines. These side effects are mostly mild and treatable.

Gender-based disparities on health indices during COVID-19 crisis: a nationwide cross-sectional study in Jordan.

BACKGROUND: COVID-19 has an inevitable burden on public health, potentially widening the gender gap in healthcare and the economy. We aimed to assess gender-based desparities during COVID-19 in Jordan in terms of health indices, mental well-being and economic burden. METHODS: A nationally representative sample of 1300 participants ≥18 years living in Jordan were selected using stratified random sampling. Data were collected via telephone interviews in this cross-sectional study. Chi-square was used to test age and gender differences according to demographics, economic burden, and health indices (access to healthcare, health insurance, antenatal and reproductive services). A multivariable logistic regression analysis was used to estimate the beta-coefficient (ß) and 95% confidence interval (CI) of factors correlated with mental well-being, assessed by patients' health questionnaire 4 (PHQ-4). RESULTS: 656 (50.5%) men and 644 (49.5%) women completed the interview. Three-fourths of the participants had health insurance during the COVID-19 crisis. There was no significant difference in healthcare coverage or access between women and men (p > 0.05). Half of pregnant women were unable to access antenatal care. Gender was a significant predictor of higher PHQ-4 scores (women vs. men: ß: 0.88, 95% CI: 0.54-1.22). Among women, age ≥ 60 years and being married were associated with significantly lower PHQ-4 scores. Only 0.38% of the overall participants lost their jobs; however, 8.3% reported a reduced payment. More women (13.89%) were not paid during the crisis as compared with men (6.92%) (P = 0.01). CONCLUSIONS: Our results showed no gender differences in healthcare coverage or access during the COVID-19 crisis generally. Women in Jordan are experiencing worse outcomes in terms of mental well-being and economic burden. Policymakers should give priority to women's mental health and antenatal and reproductive services. Financial security should be addressed in all Jordanian COVID-19 national plans because the crisis appears widening the gender gap in the economy.

Inflammatory bowel disease and prostate cancer risk: A systematic review.

Objective: To evaluate the risk of prostate cancer (PCa) in patients with inflammatory bowel disease (IBD), focussing on ulcerative colitis (UC) and Crohn's disease (CD) separately. Methods: A systemic search was carried out using PubMed and Web of Science databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We retrieved a total of 349 articles. All the articles were in the English language and investigated the incidence of PCa in patients with IBD. Results: Nine studies met our inclusion criteria, with a total of 205 037 men. Two studies reported an increase in the risk of PCa in men with IBD in general. Five other studies reported an increased risk of PCa in men with UC or with CD specifically. On the other hand, two studies reported a decreased risk of PCa in patients with UC and patients with IBD treated with aminosalicylates. Conclusions: While men with UC appear to have higher risk of developing PCa, data on patients with CD are inconclusive. Therefore, patients with UC may benefit from earlier PCa screening. Our findings confirm a complex interplay between IBD and PCa, including factors such as genetic predisposition, systemic inflammation and treatment effects. The modulatory effect of treatment strategies for IBD on the development and progression of PCa might be of clinical significance. Abbreviations: CD: Crohn's disease; CRP: C- reactive protein; FOLH1: folate hydrolase 1; GIT: gastrointestinal tract; IBD: inflammatory bowel disease; IL-6: interleukin 6; NOS: Newcastle-Ottawa Scale; PCa: prostate cancer; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PSMA: prostate-specific membrane antigen; UC: ulcerative colitis.

The impact of the COVID-19 pandemic on mental health: early quarantine-related anxiety and its correlates among Jordanians.

BACKGROUND: Jordan implemented a nationwide lockdown and recommended self-quarantine in response to the COVID-19 pandemic. Such measures are expected to have consequences on mental health. AIMS: In this study, we aimed to estimate the prevalence of quarantine-related anxiety and its socioeconomic correlates. METHODS: An online questionnaire was utilized to collect information about quarantine-related anxiety and related factors from a non-representative sample of Jordanian population in March 2020. The Beck Anxiety Inventory (BAI) was used to ascertain the level of stress. Using STATA 16, multivariable ordinal logistic regression was done to estimate beta-coefficient (ß) and corresponding 95% CI of the anxiety level. RESULTS: Overall, 5274 participants returned the survey. The prevalence of mild, moderate, and severe anxiety was 21.5%, 10.9%, and 6%, respectively. Female gender (ß= 0.47, 95% CI: 0.34 to 0.59) and more members of the household (ß= 0.04, 95% CI: 0.00 to 0.07) were correlated with a higher degree of anxiety, while older age (ß= -0.27, 95% CI: -0.33 to -0.20), having larger social network (ß= -0.17, 95% CI -0.22 to -0.13), social support (ß= -0.28, 95% CI: -0.32 to -0.23), and higher income (>2000 Jordanian Dinars vs reference, ß= -0.52, 95% CI: -0.71 to -0.33) were correlated with lower BAI scores. CONCLUSION: Our findings showed that approximately four out of every ten participants experienced quarantine-related anxiety. Younger participants, women, and people with poor social support were more likely to experience quarantine-related anxiety. These findings highlight the importance of targeting these groups to mitigate the consequence of home quarantine on public health.

The short-term impact of COVID-19 pandemic on spine surgeons: a cross-sectional global study.

PURPOSE: The outbreak of COVID-19 erupted in December 2019 in Wuhan, China. In a few weeks, it progressed rapidly into a global pandemic which resulted in an overwhelming burden on health care systems, medical resources and staff. Spine surgeons as health care providers are no exception. In this study, we try to highlight the impact of the crisis on spine surgeons in terms of knowledge, attitude, practice and socioeconomic burden. METHODS: This was global, multicentric cross-sectional study on 781 spine surgeons that utilized an Internet-based validated questionnaire to evaluate knowledge about COVID-19, availability of personal protective equipment, future perceptions, effect of this crisis on practice and psychological distress. Univariate and multivariate ordinal logistic regression analyses were used to evaluate the predictors for the degree of COVID-19 effect on practice. RESULTS: Overall, 20.2%, 52% and 27.8% of the participants were affected minimally, intermediately and hugely by COVID-19, respectively. Older ages (ß = 0.33, 95% CI 0.11-0.56), orthopedic spine surgeons (ß = 0.30, 95% CI 0.01-0.61) and those who work in the private sector (ß = 0.05, 95% CI 0.19-0.61) were the most affected by COVID-19. Those who work in university hospitals (ß = - 0.36, 95% CI 0.00 to - 0.71) were affected the least. The availability of N95 masks (47%) and disposable eye protectors or face shields (39.4%) was significantly associated with lower psychological stress (p = 0.01). Only 6.9%, 3.7% and 5% had mild, moderate and severe mental distress, respectively. CONCLUSION: While it is important to recognize the short-term impact of COVID-19 pandemic on the practice of spine surgery, predicting where we will be standing in 6-12 months remains difficult and unknown. The COVID-19 crisis will probably have an unexpected long-term impact on lives and economies.

Knowledge and Practices of Colorectal Cancer Early Detection Examinations in Jordan: A Cross Sectional Study

Background: Globally, colorectal cancer (CRC) is ranked the third most common cancer among men and the second in women. The American Cancer Society recommends that starting from the age 50 years, both men and women should be screened for polyps and for early detection of CRC. In Jordan, CRC is the most common cancer among males and the second most common cancer among females. This study aims to assess the knowledge and practices of CRC early detection tests and the barriers and motivators of screening in Jordan. Methods: A semi-structured questionnaire and face-to-face interviews were conducted with 300 males and 300 females recruited using stratified clustered random sampling technique from four governorates in Jordan. The participants were aged 30 to 65 years, without a previous history of CRC. Descriptive and multivariate analyses were used to assess knowledge and practices of CRC early detection tests. Results: Overall, there were poor knowledge and practices of CRC early detection tests. Better knowledge and practices were significantly associated with previously consulting a doctor due to symptoms and worries from CRC, receiving a recommendation from a doctor to perform CRC testing, or having more knowledge about CRC signs and symptoms (p≤ 0.05). Conclusions: This study indicates that there is a need for raising awareness about CRC early detection tests in Jordan, especially among those aged 50 years and above, and those who have a family history of CRC. Additionally, it is important to educate and encourage physicians to recommend CRC screening to patients that are at higher risk of the disease.