Factors contributing to poor COVID-19 outcomes in diabetic patients: Findings from a single-center cohort study.

Diabetes Mellitus (DM) is a frequent comorbidity in patients infected with the SARS-CoV-2 virus. The risk of developing severe or critical COVID-19 and higher mortality was observed to be increased in diabetic patients hospitalized due to COVID-19. In this study we aimed to find out the impact of clinical characteristics, comorbidities, laboratory results, and complications on the outcomes of diabetic patients hospitalized due to COVID-19. This article is a retrospective cohort study that include diabetic patients hospitalized with COVID-19 infection. A definition of diabetes was based on the past history of diabetes or if the HbA1c was 6.5% or higher. Demographics, clinical characteristics, comorbidities, laboratory results, and complications were extracted from the electronic medical records. The mortality rate increased with increasing age (from 5.56% in younger patients to 46% in the elderly) and with severity (from 25.71% in moderate cases to 43.77% in critical cases). We found that a critical severity on admission (OR: 5.26, 95% CI: 1.28-21.66, p = 0.0214), a history of stroke (OR: 8.37, 95% CI: 2.2-31.88, p = 0.0018), and low calcium levels on admission (OR: 2.23, 95% CI: 1.01-4.91, p = 0.0475) were significant risk factors predicting higher COVID-19 mortality in diabetic patients. The findings of this study suggest that reduced calcium levels could potentially indicate higher mortality due to COVID-19 in patients with DM. Furthermore, careful monitoring of diabetic patients hospitalized due to COVID-19 infection, especially those with critical disease severity or those with a history of stroke, may improve their outcome and lessen mortality.

The impact of the COVID-19 pandemic on antibiotic consumption and prevalence of pathogens in primary and secondary healthcare settings in Northern Ireland.

AIM: To evaluate the impact of the COVID-19 pandemic on the patterns of antimicrobial use and the incidence of pathogens in primary and secondary healthcare settings in Northern Ireland. METHODS: Data were collected on antibiotic use and Gram-positive and Gram-negative pathogens from primary and secondary healthcare settings in Northern Ireland for the period before (January 2015-March 2020) and during (April 2020-December 2021) the pandemic. Time series intervention analysis methods were utilized. RESULTS: In the hospital setting, the mean total hospital antibiotic consumption during the pandemic was 1864.5 defined daily doses (DDDs) per 1000 occupied-bed days (OBD), showing no significant change from pre-pandemic (P = .7365). During the pandemic, the use of second-generation cephalosporins, third-generation cephalosporins, co-amoxiclav and levofloxacin increased, there was a decrease in the percentage use of the hospital Access group (P = .0083) and an increase in the percentage use of Watch group (P = .0040), and the number of hospital Klebsiella oxytoca and methicillin-susceptible Staphylococcus aureus cases increased. In primary care, the mean total antibiotic consumption during the COVID-19 pandemic was 20.53 DDDs per 1000 inhabitants per day (DID), compared to 25.56 DID before the COVID-19 pandemic (P = .0071). During the pandemic, there was a decrease in the use of several antibiotic classes, an increase in the percentage use of the Reserve group (P = .0032) and an increase in the number of community-onset Pseudomonas aeruginosa cases. CONCLUSION: This study provides details of both changes in antibiotic consumption and the prevalence of infections in hospitals and primary care before and during the COVID-19 pandemic that emphasize the importance of antimicrobial stewardship in pandemic situations.

Acid-base imbalance as a risk factor for mortality among COVID-19 hospitalized patients.

Severe coronavirus disease 2019 (COVID-19) infection can lead to extensive lung infiltrate, a significant increase in the respiratory rate, and respiratory failure, which can affect the acid-base balance. No research in the Middle East has previously examined acid-base imbalance in COVID-19 patients. The present study aimed to describe the acid-base imbalance in hospitalized COVID-19 patients, determine its causes, and assess its impact on mortality in a Jordanian hospital. The study divided patients into 11 groups based on arterial blood gas data. Patients in normal group were defined as having a pH of 7.35-7.45, PaCO2 of 35-45 mmHg, and HCO3- of 21-27 mEq/L. Other patients were divided into 10 additional groups: mixed acidosis and alkalosis, respiratory and metabolic acidosis with or without compensation, and respiratory and metabolic alkalosis with or without compensation. This is the first study to categorize patients in this way. The results showed that acid-base imbalance was a significant risk factor for mortality (P<0.0001). Mixed acidosis nearly quadruples the risk of death when compared with those with normal levels (OR = 3.61, P=0.05). Furthermore, the risk of death was twice as high (OR = 2) for metabolic acidosis with respiratory compensation (P=0.002), respiratory alkalosis with metabolic compensation (P=0.002), or respiratory acidosis with no compensation (P=0.002). In conclusion, acid-base abnormalities, particularly mixed metabolic and respiratory acidosis, were associated with increased mortality in hospitalized COVID-19 patients. Clinicians should be aware of the significance of these abnormalities and address their underlying causes.

Public knowledge of antibiotics, self-medication, and household disposal practices in Jordan.

BACKGROUND: This study aimed to assess public understanding of antibiotics, self-medication, and drug disposal practices. METHODS: A cross-sectional self-administered online survey was undertaken in Jordan. RESULTS: The study was completed by 1,105 participants. When asked about their knowledge of antibiotics, rational antibiotic use, and disposal practices, 16% percent believed they should discontinue antibiotics once they felt better, and 12% agreed to take the same antibiotics prescribed to others for the same illness. Self-medication with antibiotics was practiced by 44% of the participants. Prior experience, healthcare costs, and pharmacy location were all major determinants of self-medication. Only 6.4% of unneeded antibiotics were returned to the pharmacy, 60% were kept at home, and 26.6% were disposed of at home. Almost half of those who kept the antibiotics said they would use them again, and one-third said they would give them to friends and family. Respondents who had used antibiotics within the previous 6 months (p = 0.052) and relied on medication leaflets (p = 0.031) and physician recommendations (p = 0.001) were less likely to self-medicate with antibiotics. CONCLUSIONS: The study highlighted areas of inappropriate use of antibiotics, self-medication and the improper antibiotic disposal that can inform antimicrobial stewardship.

Antibiotic use and resistance: Information sources and application by dentists in Jordan.

INTRODUCTION: The availability of evidence-based information sources for dentists is essential to influence antibiotic prescribing practices and we need to understand how dentists interact with such sources and how this influences their practice. The present study aimed to evaluate dentists' preferred sources of information and their awareness of available information and initiatives on prudent antibiotic prescribing practices in Jordan. METHODOLOGY: An online cross-sectional questionnaire was administered to dentists between July to September 2021. It was an adapted version of the European Centre for Disease Prevention and Control (ECDC) survey for antibiotic use and resistance. RESULTS: A total of 204 dentists responded to the survey. The main sources of information regarding avoiding unnecessary antibiotic prescribing were published guidelines (35.5%), the dental professional body (20.0%), colleagues or peers (18.6%), and scientific organizations (17.2%), with the influence of these sources on changing prescribers' views being 40.7%, 9.8%, 10.3%, and 14.2%, respectively. Of the surveyed dentists, 9.3%, 33.8%, and 56.9% were aware, unaware, and unsure of the presence of national action plans on antimicrobial resistance, respectively. Dentists reported their desire to receive more information about resistance to antibiotics (57.8%), medical conditions for which antibiotics are used (52.9%), how to use antibiotics (41.2%), prescribing of antibiotics (39.7%), and links between the health of humans, animals, and the environment (26.0%). CONCLUSIONS: The study provided insights into the information available to and used by dentists, which can inform effective antimicrobial stewardship strategies for improving antibiotic prescribing.

Knowledge, Attitude, and Behavior about Antimicrobial Use and Resistance among Medical, Nursing and Pharmacy Students in Jordan: A Cross Sectional Study.

The present study aimed to survey medical, nursing and pharmacy students' knowledge, attitude and practice regarding antimicrobial use and resistance. Additionally, the study assessed the teaching and assessment activities received regarding antibiotic use. A cross sectional online survey was distributed to undergraduate students currently in clinical studies in their degree program. A total of 716 medicine, nursing and pharmacy undergraduate students were included. Respondents scored more than 76% on knowledge on effective use, unnecessary use and associated side effects of antibiotics, and 65.2% regarding knowledge on the spread of antibiotic resistance. Some participants (21.0%) agreed or strongly agreed that there has been good promotion of prudent antimicrobial use. Students were aware (13.1%), unaware (29.1%), or unsure (57.8%) that there is a national action plan relating to antimicrobial resistance. A total of 62.8% of the respondents strongly agreed or agreed that they have a key role in helping control antibiotic resistance. Participants reported that they require more information about resistance to antibiotics (53.9%), medical conditions for which antibiotics are used (51.7%) and how to use antibiotics (51.0%). Discussion of clinical cases and vignettes and small group teaching were reported as very useful or useful teaching strategies (79.9% and 74.2%, respectively). The findings from this study determined the current situation in relation to education on prudent antimicrobial use for undergraduates and highlighted areas for informing better curriculum design.

Risk Factors Associated with Mortality in COVID-19 Hospitalized Patients: Data from the Middle East.

This study aimed to assess the risk factors for COVID-19 mortality among hospitalized patients in Jordan. All COVID-19 patients admitted to a tertiary hospital in Jordan from September 20, 2020, to August 8, 2021, were included in this study. Demographics, clinical characteristics, comorbidities, and laboratory results were extracted from the patients' electronic records. Multivariable logistic and machine learning (ML) methods were used to study variable importance. Out of 1,613 COVID-19 patients, 1,004 (62.2%) were discharged from the hospital (survived), while 609 (37.8%) died. Patients who were of elderly age (>65 years) (OR, 2.01; 95% CI, 1.28-3.16), current smokers (OR, 1.61; 95%CI, 1.17-2.23), and had severe or critical illness at admission ((OR, 1.56; 95%CI, 1.05-2.32) (OR, 2.94; 95%CI, 2.02-4.27); respectively), were at higher risk of mortality. Comorbidities including chronic kidney disease (OR, 2.90; 95% CI, 1.90-4.43), deep venous thrombosis (OR, 2.62; 95% CI, 1.08-6.35), malignancy (OR, 2.22; 95% CI, 1.46-3.38), diabetes (OR, 1.31; 95% CI, 1.04-1.65), and heart failure (OR, 1.51; 95% CI, 1.02-2.23) were significantly associated with increased risk of mortality. Laboratory abnormalities associated with mortality included hypernatremia (OR, 11.37; 95% CI, 4.33-29.81), elevated aspartate aminotransferase (OR, 1.81; 95% CI, 1.42-2.31), hypoalbuminemia (OR, 1.75; 95% CI, 1.37-2.25), and low platelets level (OR, 1.43; 95% CI, 1.05-1.95). Several demographic, clinical, and laboratory risk factors for COVID-19 mortality were identified. This study is the first to examine the risk factors associated with mortality using ML methods in the Middle East. This will contribute to a better understanding of the impact of the disease and improve the outcome of the pandemic worldwide.

Predictors of invasive mechanical ventilation in hospitalized COVID-19 patients: a retrospective study from Jordan.

OBJECTIVES: To identify early indicators for invasive mechanical ventilation utilization among COVID-19 patients. METHODS: This retrospective study evaluated COVID-19 patients who were admitted to hospital from 20 September 2020, to 8 August 2021. Multivariable logistic regression and machine learning (ML) methods were employed to assess variable significance. RESULTS: Among 1,613 confirmed COVID-19 patients, 365 patients (22.6%) received invasive mechanical ventilation (IMV). Factors associated with IMV included older age >65 years (OR,1.46; 95%CI, 1.13-1.89), current smoking status (OR, 1.71; 95%CI, 1.22-2.41), critical disease at admission (OR, 1.97; 95%CI, 1.28-3.03), and chronic kidney disease (OR, 2.07; 95%CI, 1.37-3.13). Laboratory abnormalities that were associated with increased risk for IMV included high leukocyte count (OR, 2.19; 95%CI, 1.68-2.87), low albumin (OR, 1.76; 95%CI, 1.33-2.34) and high AST (OR, 1.71; 95%CI, 1.31-2.22). CONCLUSION: Our study suggests that there are several factors associated with the increased need for IMV among COVID-19 patients. These findings will help in early identification of patients at high risk for IMV and reallocation of hospital resources toward patients who need them the most to improve their outcomes.

Global Research Trends of Health-Related Publications on Ramadan Fasting from 1999 to 2021: A Bibliometric Analysis.

Ramadan fasting is one of the five pillars of Islam. The current study aims to examine, analyze, and identify trends of health-related publications on Ramadan fasting. In total, 1468 documents retrieved from Scopus were analyzed. The mean number of authors per document was 3.7, with an average of 13.3 citations per document. The UK ranked first (12.3%, n = 181) regarding the number of documents, followed by Iran (10.4%, n = 153) and then Saudi Arabia (9.8%, n = 144). The most active journal was "Diabetes Research and Clinical Practice" (4.9%, n = 72). Publications related to diabetes and fasting constituted around 29.7% (n = 436) of the literature. The research volume on Ramadan fasting has been noticeably growing. More reliable research is required to aid healthcare professionals in providing patient-specific care.

Smartphone applications for sleep tracking: rating and perceptions about behavioral change among users.

Introduction: This study aims to assess existing sleep apps for mobile phones to determine the perceived effect of these applications on user's attitudes, knowledge, willingness to change, and its likelihood to change behavior from a user's perspective. Material and Methods: A systematic search was conducted through Google play store and iTunes Apple store using terms related to sleep tracking. Apps were evaluated using Mobile Application Rating Scale (MARS) tool for assessing and classifying mobile health applications quality. Additionally, a convenience sample of subjects were asked to evaluate the included apps for perceived sleep behavior changes. Results: The average MARS app quality score on a 5-point scale was 3.3. Between 30-50% of participants believed that sleep tracker apps are likely to increase awareness about sleep patterns and sleep hygiene, infuence sleep hygiene habits, and are likely to encourage help seeking for sleep hygiene when required. Conclusion: Apps available for sleep self-management and tracking may be valuable tools for self-management of sleep disorder and/or improving sleep quality, yet they require improvement in terms of quality and content, highlighting the need for further validity studies.

Knowledge, practices, and patterns of data confidentiality among pharmacists in a developing country.

Background: Increased application of electronic health information systems led to the buildup of patient information and facilitated access to this data. Consequently, the confidentiality of this information became an ethical challenge to medical teams' members including pharmacists. However, no study has been conducted to assess pharmacists' knowledge or practices of data confidentiality. Thus, the aim of this study was to assess the current practices and knowledge of pharmacists concerning data confidentiality. Methods: This was a cross sectional study that included clinical pharmacists in tertiary hospitals and health care centers in Jordan. Data was collected through phone or face to face interviews using a data collection sheet. All continuous data was presented as median ± interquartile range (IQR) and categorical data as frequency (%). One way Chi square was used to check significant differences among categorical groups. Predictors that may affect knowledge and behavior scores were screened using simple linear regression. Results: A total of 388 pharmacists were interviewed with a mean age of 39.59 ± 8.32 years, with an average experience of 12.55 ± 7.30 years. Pharmacists relied on their personal experience to resolve ethical dilemmas (n = 274, 70.3%), and when they seek advice, their work colleagues (n = 180, 46.4%) %), followed by the head of departments (144 n; 37.1%), were the main source of advice on ethical issues. The overall median knowledge score of pharmacists about data confidentiality was 2.0 out of 5.0 (IQR = 2.0). A considerable percentage of the pharmacists was willing to share information with family members without asking for permission from the patient (n = 98, 25.3%). Pharmacists had a median behavior score of 3.5 out of 4.0 (IQR = 0.4) regarding practices related to data confidentiality, where the majority of them handled medical information from the patient with great confidentiality (304 n, 78.4%), and 85.8% of them (n = 333) gave patient's sexual diseases-related medical information the highest confidentiality. However, based on univariate and multivariate linear regression analysis, none of the examined sociodemographic variables significantly predicted pharmacists' knowledge or behaviors (P > 0.05). Conclusion: Pharmacists are aware of the importance of confidentiality issues of their patients. However, a number of gaps in their knowledge and practices of data confidentiality were identified. Training that targets these gaps in their knowledge, and rectifies incorrect practices is needed during university education and as part of their continuous medical education.

Prevalence Estimates and Risk Factors of Anxiety among Healthcare Workers in Jordan over One Year of the COVID-19 Pandemic: A Cross-Sectional Study.

This study investigates the changes in prevalence estimates, severity, and risk factors of anxiety among healthcare workers (HCWs) over the first year of the COVID-19 pandemic. A survey was distributed among HCWs using snowball sampling, collecting their socio-demographics, occupation, and anxiety symptoms as measured by the Generalized Anxiety Disorder-7 (GAD-7) scale. It was distributed one month after the pandemic's onset in Jordan between 15 and 30 April 2020 (onset group) and after one year between 15 and 30 March 2021 (one-year group). A total of 422 HCWs were included (211 in each group). The one-year group reported a higher risk of GAD (30.8% vs. 16.6%; p = 0.001), a higher mean (SD) GAD-7 score (7.94 (5.29) vs. 6.15 (4.15); p < 0.001), and more severe symptoms (p = 0.003). Univariate analyses showed that participants who were younger, women, unmarried, had lower monthly incomes, underwent testing for COVID-19, had higher contact with COVID-19 patients, did not receive special education, and were unsatisfied with the institutional COVID-19 preparedness scored higher on the GAD-7 scale and had more severe symptoms than their counterparts in both groups. Unlike the onset group, occupation as a physician, COVID-19 infection history, and perception of remarkable changes in work were associated with higher anxiety scores and severity among the one-year group. The COVID-19 vaccine was a relative protective action. Logistic regression analyses showed that the female gender was a risk factor for developing GAD at the pandemic onset, while poor satisfaction with institutional preparedness was a significant GAD risk factor in the one-year group. Low monthly income and lack of special education were the shared risk factors for GAD in both groups. This study reveals a significant rise in anxiety among HCWs over a year of the COVID-19 pandemic and shows the vulnerable sub-groups who likely need psychological interventions.

Pharmacists' Knowledge, Attitudes, Behaviors and Information Sources on Antibiotic Use and Resistance in Jordan.

Antimicrobial resistance (AMR) is a serious healthcare problem that affects public health globally. Appropriate understanding and knowledge of prudent antimicrobial use and resistance, along with providing evidence-based information sources, are needed for informed antibiotic prescribing practices. This study aimed to assess the knowledge, opportunity, motivation, behavior of pharmacists and their information sources regarding antibiotic use and resistance in Jordan. An online cross-sectional questionnaire was developed and administered to pharmacists during the period of July-September 2021. The survey is an adapted version of the validated European Centre for Disease Prevention and Control (ECDC) survey for antibiotic use and resistance. Pharmacists from all sectors (n = 384), of whom 276 (71.9%) were community pharmacists, completed an online questionnaire. While respondents scored highly (>87%) on knowledge on effective use, unnecessary use, and associated side effects of antibiotics, lower scores were recorded for knowledge on the spread of antibiotic resistance (52.9%). Pharmacists support easy access to guidelines on managing infections in 56% of cases, and easy access to materials advising prudent antibiotic use and resistance in 39.8% of cases. One-third of respondents (37.0%) reported no knowledge of any initiatives on antibiotic awareness and resistance. Pharmacists were aware (13.3%), unaware (36.2%), or unsure (50.5%) of the existence of a national antibiotic resistance action plan. Pharmacists indicated an interest in receiving more information on resistance to antibiotics (55.2%), medical conditions for which antibiotics are used (53.1%), how to use antibiotics (45.1%), prescribing of antibiotics (34.4%), and links between the health of humans, animals, and the environment (28.6%). Findings can inform antimicrobial stewardship with required interventions to improve antibiotic use.

The impact of health literacy on self-medication: a cross-sectional outpatient study.

Although health literacy practices have been increasingly recommended in public health literature, there is a lack of studies that examine the relationships between health literacy and self-medication. BACKGROUND: This research project aims to measure and evaluate the impact of health literacy on self-medication and to achieve a better understating of patients' behaviors. METHODS: A cross-sectional approach was conducted and participants were recruited outpatient clinics through convenience sampling. Health literacy was measured by Single Item Literacy Screener. RESULTS: A total of 194 participants agreed to participate (63.9% were females). The results showed that more than half (57.2%) had adequate health literacy. Almost 30% of the participants were over the age of 50. The prevalence of self-medication was 74.2%. Nearly, two-thirds of the total participants reported self-administration of antibiotics. There was a significant relationship between the overall health literacy level and practice of self-medication. CONCLUSIONS: Improving the health literacy level of the public can reduce inappropriate self-medication, especially the self-medication with antibiotics, which represented a high prevalence situation in our sample. Appropriate reading skills are important for accessing health information, using health care services, and achieving desirable health outcomes.

Trends in Insomnia, Burnout, and Functional Impairment among Health Care Providers over the First Year of the COVID-19 Pandemic.

Background: COVID-19 pandemic has negatively impacted the psychological well-being and quality of life of health care providers (HCPs). Objectives: This study assessed the trends in prevalence and predictors of insomnia, burnout, and functional impairment among HCPs over the first year of the pandemic. Methods: An online survey was conducted one month after the pandemic's onset (onset group) and a year later (one-year group). The demographic features of participants were collected. Insomnia, burnout, and functional impairment were assessed using Insomnia Severity Index (ISI), Mini-Z survey, and Sheehan Disability Scale (SDS), respectively. Results: The onset group included 211 HCPs (mean (SD) age 34.7 (9.3) years and 73% men), while 212 HCPs participated in the one-year survey (mean (SD) age 35.9 (10.5) years and 69% men). High prevalence estimates were found in both onset and one-year groups of symptoms of insomnia (52% vs. 49%), of diagnosis of clinical insomnia (15% vs. 18%), with a high mean ISI score (8.4 vs. 8.7), but with no significant difference between the onset and one-year groups. Risk factors for clinical insomnia included age in both groups, lower income and contact level with COVID-19 patients/samples in the onset group, and lower Mini-Z scores and higher SDS scores in the one-year group. Approximately one-third of respondents reported at least one or more burnout symptoms, with a higher percentage in the one-year group (35.4%) than in the onset group (24.2%) (p=0.012). Younger age, lower monthly income, and higher ISI and SDS scores were risk factors for burnout in both groups. Greater perceived changes in social life were associated with burnout in the onset group. In contrast, higher weekly working hours, worse participants' evaluation of their institution's preparation, and more changes in workload were risk factors for burnout in the one-year group. The SDS score and its subscales scores were higher in the one-year group than in the onset group. Changes in workload and social life predicted higher SDS scores among both groups. Living with older people predicted higher SDS scores among the onset group, while contact level and estimated number of COVID-19 patients that participants engaged in during caring predicted higher SDS scores among the one-year group. ISI scores were significantly correlated with the Mini-Z scores and SDS scores in both groups, while the Mini-Z and SDS scores were significantly correlated only in the one-year group. Conclusion: This study demonstrated high rates of insomnia, burnout, and functional impairment among HCPs during the pandemic. It reveals a significant rise in job burnout and functional impairment of HCPs overtime during the pandemic. Furthermore, high-risk subgroups are also highlighted for whom comprehensive psychosocial and occupational interventions might be warranted.

Public Health Literacy, Knowledge, and Awareness Regarding Antibiotic Use and Antimicrobial Resistance during the COVID-19 Pandemic: A Cross-Sectional Study.

Multi-drug-resistant (MDR) organisms pose a global threat to modern medicine, which has grown as a result of irrational antibiotic use and misuse. This study aimed to assess general public knowledge in Jordan and awareness of antibiotics and antibiotic resistance during the COVID-19 pandemic. A cross-sectional study was carried out utilizing the WHO multicountry public awareness survey. The study population was composed mainly of social media users, and a total of 1213 participants completed the online survey. According to the findings, more than half of the participants were well versed in antibiotic use and resistance. Those with adequate health literacy were found to better understand antibiotics (OR = 1.37, p = 0.017) and antibiotic resistance (OR = 1.46, p = 0.003). The vast majority (88.5%) recognized at least one antibiotic resistance term; however, 53.2% believed that antibiotic resistance is a problem in other nations. The participants in this study reported using antibiotics incorrectly, believing that they were treating sore throats, colds, and flu. The participants were well aware of antibiotic resistance solutions and their consequences on health. Age, education, health literacy, and antibiotic knowledge were found to be substantially (p < 0.05) associated with greater awareness of antibiotic resistance. The findings highlight the need for antimicrobial resistance education campaigns, health literacy, and antibiotic stewardship initiatives.

Prescribers' Knowledge, Attitudes and Behaviors on Antibiotics, Antibiotic Use and Antibiotic Resistance in Jordan.

More research is needed on the drivers of irrational antibiotic prescribing among healthcare professionals and to ensure effective prescribing and an adequate understanding of the issue of antibiotic resistance. This study aimed at evaluating prescribers' knowledge, attitudes and behaviors about antibiotic use and antibiotic resistance. A cross-sectional study was conducted utilizing an online questionnaire and included physicians and dentists from all sectors in Jordan. A total of 613 prescribers were included (physicians n = 409, dentists n = 204). Respondents' knowledge on effective use, unnecessary use or associated side effects of antibiotics was high (>90%), compared with their knowledge on the spread of antibiotic resistance (62.2%). For ease of access to the required guidelines on managing infections, and to materials that advise on prudent antibiotic use and antibiotic resistance, prescribers agreed in 62% and 46.1% of cases, respectively. 28.4% of respondents had prescribed antibiotics when they would have preferred not to do so more than once a day or more than once a week. Among respondents who prescribed antibiotics, 63.4% would never or rarely give out resources on prudent use of antibiotics for infections. The findings are of importance to inform antibiotic stewardships about relevant interventions aimed at changing prescribers' behaviors and improving antibiotic prescribing practices.

Exploring Information Available to and Used by Physicians on Antibiotic Use and Antibiotic Resistance in Jordan.

Evidence based information sources for physicians are needed for informed antibiotic prescribing practices. The aim of this study was to explore physicians' preferred sources of information and evaluate physicians' awareness of available information and initiatives on prudent antibiotic prescribing in Jordan. A cross-sectional study was conducted utilizing an online questionnaire and included physicians (n = 409) from all sectors and specialties in Jordan. Published guidelines (31.8%), the workplace (25.7%), colleagues or peers (20.0%), group or conference training (18.3%), and the medical professional body (18.1%) were the main sources of information about avoiding unnecessary antibiotic prescribing, with the influence of these sources on changing prescribers' views being 34.7%, 17.1%, 11%, 13.4%, and 7.6%, respectively. One-third of physicians (33.7%) reported no knowledge of any initiatives on antibiotic awareness and resistance. Regarding awareness of national action plans on antimicrobial resistance, 10.5%, 34%, and 55.5% of physicians were aware, unaware, and unsure of the presence of any national action plans, respectively. Physicians showed interest in receiving more information on resistance to antibiotics (58.9%), how to use antibiotics (42.2%), medical conditions for which antibiotics are used (41.3%), prescribing of antibiotics (35.2%), and links between the health of humans, animals, and the environment (19.8%). The findings can inform interventions needed to design effective antimicrobial stewardship, enabling physicians to prescribe antibiotics appropriately.

Trends in maternal characteristics, and maternal and neonatal outcomes of women with gestational diabetes: A study from Jordan.

BACKGROUND: Gestational diabetes mellitus (GDM) is a major health issue that poses its risk on pregnancy. It is prevalence has been globally increasing. AIM: This study aimed to examine trends in demographic and socioeconomic characteristics, maternal BMI, behavioral factors, obstetric interventions, pregnancy complications, and maternal pre-existing medical conditions and maternal and neonatal outcomes in women with GDM in Jordan. We also aimed to equate the occurrence of emergency cesarean delivery with GDM. METHODS: The study is a part of a comprehensive national study of perinatal mortality that was conducted in Jordan. This study included all women who gave birth in the selected hospitals during the study period. Maternal and medical conditions during pregnancy and neonatal outcomes were compared among women who did not develop gestational diabetes mellitus and those who developed gestational diabetes mellitus. RESULTS: The overall incidence rate of gestational diabetes mellitus (GDM) was 1.2%. Women with gestational diabetes had a higher weight, and BMI, more likely to be overweight, obese, or morbidly obese and less likelihood to be underweight. A significant association was detected between previous spontaneous abortions/miscarriages, previous preterm, previous stillbirths, previous children born with birth weight less than 2500 g, and previous children born alive and died before 28 days, and the incidence of GDM. Women with GDM were at high risk for complications in pregnancy such as hypertension, preeclampsia, premature delivery and labor induction. The offspring of GDM patients were at high risk of complications such as macrosomia, stillbirth, neonatal hypoglycemia, and neonatal jaundice and admittance to the NICU. CONCLUSIONS: The incidence of GDM was linked to several clinical factors. Women with GDM are at high risk for complications of pregnancy and at higher risk of neonatal complications.

Knowledge and Practice of Patients' Data Sharing and Confidentiality Among Nurses in Jordan.

BACKGROUND: The key patient rights entail respecting human decency, receiving healthcare services of high-quality, the right to information, the initial agreement of the patient to medical intervention, respecting privacy and personal life, and sustaining care and treatment. This study aims to survey the knowledge and practice of nurses in various healthcare industries toward sharing and confidentiality of patients' data. METHODS: A descriptive cross-sectional design was employed through an online survey from May to June 2020. The authors sent a developed tool containing 19 statements reflecting the understanding of nurses' knowledge and practice of privacy and sharing of data required to safeguard patient privacy. A total of 800 nurses agreed to participate in the study out of 1000 nurses. RESULTS: Roughly, all participants agreed that junior nurses should participate in a data sharing and confidentiality course before engaging in practice. Regarding institution policies for data sharing and protection, many nurses agreed that there are special recommendations and instructions from the institution in which they work to exchange patient information among nurses and the medical staff. The predictors of sharing practices and confidentiality among nurses include age, gender, marriage status, and attending a security course before practice. Young age, female, not attending a data sharing course, and single nurses are less engaging with data sharing and confidentiality of the patients for unauthorized patients. CONCLUSION: A significant proportion of the staff had appropriate practices that ensured data security. However, practices that ensure patient confidentiality in the aspects of access, sharing, and transferring of patient data need improvement. Training is essential since it will have a beneficial relationship with knowledge, opinions, views, and actions. Thus, planning continuous training on policies and regulations about data safety and privacy may assist in improving healthcare setting practices.