COVID-19: Factors associated with psychological distress, fear, and coping strategies among community members across 17 countries.

BACKGROUND: The current pandemic of COVID-19 impacted the psychological wellbeing of populations globally. OBJECTIVES: We aimed to examine the extent and identify factors associated with psychological distress, fear of COVID-19 and coping. METHODS: We conducted a cross-sectional study across 17 countries during Jun-2020 to Jan-2021. Levels of psychological distress (Kessler Psychological Distress Scale), fear of COVID-19 (Fear of COVID-19 Scale), and coping (Brief Resilient Coping Scale) were assessed. RESULTS: A total of 8,559 people participated; mean age (±SD) was 33(±13) years, 64% were females and 40% self-identified as frontline workers. More than two-thirds (69%) experienced moderate-to-very high levels of psychological distress, which was 46% in Thailand and 91% in Egypt. A quarter (24%) had high levels of fear of COVID-19, which was as low as 9% in Libya and as high as 38% in Bangladesh. More than half (57%) exhibited medium to high resilient coping; the lowest prevalence (3%) was reported in Australia and the highest (72%) in Syria. Being female (AOR 1.31 [95% CIs 1.09-1.57]), perceived distress due to change of employment status (1.56 [1.29-1.90]), comorbidity with mental health conditions (3.02 [1.20-7.60]) were associated with higher levels of psychological distress and fear. Doctors had higher psychological distress (1.43 [1.04-1.97]), but low levels of fear of COVID-19 (0.55 [0.41-0.76]); nurses had medium to high resilient coping (1.30 [1.03-1.65]). CONCLUSIONS: The extent of psychological distress, fear of COVID-19 and coping varied by country; however, we identified few higher risk groups who were more vulnerable than others. There is an urgent need to prioritise health and well-being of those people through well-designed intervention that may need to be tailored to meet country specific requirements.

Predictors of breakfast skipping among 14 to 16 years old adolescents in Jordan: The influential role of mothers.

AIM: To assess the prevalence and identify the predictors of breakfast skipping among 14- to 16-year-old adolescents in Jordan, focusing on mother-related variables. BACKGROUND: Breakfast is an essential meal across one's entire lifespan and especially important during the adolescent years. The practice of skipping breakfast has become so prevalent among adolescents that it is now a well-documented nutritional problem. DESIGN: A descriptive cross-sectional correlational design. METHODS: A proportional cluster stratified sampling protocol was used to select 1896 adolescents and their mothers (1013) during the period of March to June 2016. A self-reported questionnaire was used to collect data on breakfast-skipping rates, the perceived reasons for this behavior, the perceived importance of consuming breakfast, and maternal encouragement of breakfast consumption. RESULTS: The prevalence of breakfast skipping was 34.3% among adolescents and 21.5% among their mothers. A significant association was found between breakfast skipping among adolescents and their mothers (χ2 [1, n = 998] = 37.90, P = .001). Maternal encouragement of breakfast consumption, gender, and adolescent perception of the importance of this meal were found to be significant predictors of adolescent breakfast skipping. CONCLUSION: The findings highlight the importance of involving mothers in developing nutritional health plans aimed at promoting regular breakfast consumption among adolescents.

Disordered eating in Jordanian adolescents.

BACKGROUND: Disordered eating attitudes and behaviours are linked to poor physical and psychological outcomes. AIM: To examine the individual, psychological, and socio-cultural factors associated with disordered eating attitudes among Jordanian adolescents. METHODS: A stratified sampling method was used to select school students aged 15 to 18 years from three governates in Jordan in 2013/2014. Participants filled out questionnaires on socio-demographic variables, the Eating Attitudes Test (EAT-26; to discriminate adolescents with disordered eating); the Body Shape Questionnaire (BSQ; used to measure psychological factors associated with disordered eating); Body Mass Index was calculated and obesity evaluated according to international cut off points (to categorize normal weight, overweight, and obese adolescents, and these categories were used as individual factors associated with disordered eating). RESULTS: A total of 963 (460 boys and 503 girls) participated in the study. Disordered eating (EAT score ≥ 20) was present in 389 (40.4%); body shape dissatisfaction (BSQ scores ≥110) was present in 161 (16.8%). Overweight and obesity were found in 332 (34.5%) participants. Unhealthy weight loss behaviours (such as self-induced vomiting, substance abuse, and smoking) were very common. Multivariate logistic regression analysis demonstrated that female sex, urban residence, distorted perceptions of weight, BMI (excess weight), body dissatisfaction, and socio-cultural variables (parents, peers and mass media) were significantly associated with disordered eating. CONCLUSION: Jordanian urban adolescents seem to embrace Western norms to fit in with the demands of Western culture. Socio-cultural factors, particularly mass media, play a significant role in changing adolescents' norms. Prevention and intervention programs are needed to control these disorders.

Young women's experience of adolescent marriage and motherhood in Jordan.

Adolescent pregnancy and early motherhood are associated with poor social and physical outcomes. This study explored the experiences of marriage and motherhood among Jordanian young women. A descriptive qualitative design was employed. Participants (n = 15, age 15-37 years) who had experienced adolescent marriage and motherhood and who lived in eastern Amman, the capital of Jordan, were selected via snowball sampling. Data were collected by tape-recorded face-to-face interviews and analysed thematically. Five themes were identified: lost opportunities for personal development, learning to be submissive and indecisive, uncertainty toward cultural norms, ambivalent feelings toward a maternal role and empowering oneself to face life demands. The findings indicate that the experience of marriage and motherhood among Jordanian adolescents was mostly negative; they felt that they had been deprived of their rights, respect and the experience of being a young person. Additionally, they felt that the transition into motherhood was very difficult, and that they were prematurely forced into adult social roles and responsibilities, which caused them to experience numerous challenges. Adolescent mothers are a vulnerable group that should be better targeted by prevention and intervention measures.

A Survey on Sexual Counseling for Patients With Cardiac Disease Among Nurses in Jordan.

BACKGROUND: Recovery among patients with cardiac disease also requires attention to their sexual health. However, cultural, religious, and social factors may make Arab Muslim patients reluctant to disclose their sexual concerns and nurses hesitant to discuss patients' sexuality matters. OBJECTIVE: The aim of this study was to explore sexual counseling (SC) among nurses in Jordan in terms of responsibility, confidence, and practice. METHOD: This was a descriptive, correlational study. Staff nurses were recruited from 10 hospitals in Jordan. Nurses completed the cardiac version of the Survey of Sexuality-Related Nursing Practice and reported their demographics. RESULTS: The sample consisted of 379 nurses (female, 59%; mean age, 28.1 years). A significant proportion of nurses viewed assessment/discussion of patients' sexuality matters as not within their responsibilities (39%), did not feel confident to address sexuality matters (50%), and rated themselves as not at all/not very knowledgeable about sexuality (60%). Few nurses were routinely integrating SC in clinical practice (9%). Sexual counseling was associated with nurses' gender (male, higher confidence and practice) and previous training on sexuality in nursing practice. CONCLUSIONS: Nurses in Jordan, especially female nurses, are neither prepared nor competent to provide SC. Nurses need focused education on sexuality to optimize patients' sexual health.

Epidemiology of Nonfatal Injuries Among Schoolchildren.

Nonfatal injuries are considered as one of the major public health hazards affecting schoolchildren, and the majority of these injuries occur at school or in the home. A cross-sectional study was conducted over a period of 3 months, March-May 2015. The participants were 4,355 Jordanian schoolchildren in Grades 7-12. The Pearson χ(2) test was computed, and the odds ratio was used to determine the magnitude of various risk factors for nonfatal injuries among schoolchildren. The overall incidence of nonfatal injury was 33.9%. The group most likely to sustain nonfatal injuries was boys, aged 12-15, in Grade 7, whose parents had a low level of education or a high family income. Injury prevention in schools and at homes is a cornerstone for protection or reducing the incidence of injuries. School nurses have a duty to follow up and examine the accident reports and evaluate whether safety policies are applied and are effective in different school settings. Furthermore, health and education authorities should develop a national program for preventing injuries.

Predictors of non-adherence to follow-up visits and deferasirox chelation therapy among jordanian adolescents with Thalassemia major.

Poor adherence to treatment can have negative effects on outcomes and heath care cost. However, little is known about the factors that impact adherence to deferasirox chelation therapy. The aims of this study were to identify rates and predictors of non-adherence to medical regimen among thalassemia major adolescents on deferasirox oral chelation therapy by using subjective (self-reporting) and objective (serum ferritin and follow-up visits) measures. Convenient samples of 164 adolescents, aged 12-19 years were recruited from three National Thalassemia Centers in Jordan. Patients were interviewed using a four-section questionnaire and the medical records were checked. Results indicated that rate of adherence according to self-report was (73%); while to follow-up medical appointments and serum ferritin level rates was 57% and 47%, respectively. One-third of participant adolescents (n = 52) were psychologically impaired. Multivariate analysis showed that factors affecting adolescent non-adherence to deferasirox chelation therapy is different from that affecting adherence to follow-up visits. In general, adolescents more than 16 years old, presence of sibling with thalassemia, lack of parental monitoring, lower family income, decrease frequency of blood transfusion, and psychological impairment were found significant predictors of non-adherence among adolescents. Disease knowledge was not associated with adherence status of the adolescents. Clinician should be aware of high prevalence of low adherence to chelation therapy during adolescent years. Nurses need to regularly assess, monitor, and promote adherence behavior that might impact patients' outcomes.

Impact of psychosocial status and disease knowledge on deferoxamine adherence among thalassaemia major adolescents.

This cross-sectional study aimed to explore the relationship between psychosocial status, disease knowledge and adherence to deferoxamine treatment in adolescents with thalassaemia major. A purposive sample of 36 adolescents with transfusion dependence, ages 12-19 years, was recruited. A semi-structured interview and two structured questionnaires were used. In this sample, 56% were low adherence and 36% were psychologically impaired. Statistically significant factors associated with psychological impairment were: adolescents more than 16 years; low deferoxamine adherence; mean ferritin more than 2500 µg/L; family size more than six; family income equal or less than 350 Jordanian dinar and having sibling with thalassaemia. Additionally, adolescents with high level of knowledge had significantly lower scores on Pediatric Symptom Checklist.

Nursing students evaluation of problem based learning and the impact of culture on the learning process and outcomes: a pilot project.

PURPOSES: This study evaluates students' learning experiences in a clinical pediatric nursing course adopting Problem Based Learning (PBL) and investigates how students' cultural background impacts on self directed learning. METHODS: A mixed-methods approach combining quantitative and qualitative methods was utilized to answer the research objectives. An observational technique for the PBL teaching sessions was employed; and 226 third-year students were asked to complete PBL evaluation questionnaire. RESULTS: Fifty seven percent (n = 130) responses to the questionnaire were analyzed. Overall, students considered PBL to be moderately effective in their learning experience, with a mean of 3.64 (S.D = 1.18). Students qualitative responses fell within four thematic categories including: developing cognitive abilities, independent learning, motivation to learn, and group learning. Difficulties encountered by students were: it is time-consuming, it has unclear objectives, it is a stressful process, and it results in an increased workload. A small number of students indicated that PBL tutorials were boring and complained about lack of contribution from instructors and limited recourses. Learning is intertwined with culture; students' previous educational experiences, uncertainty, English language proficiency, computer resources, gender, and achievement were identified as the most important cultural issues that impact the learning process and outcomes. CONCLUSION: Successful implementation of PBL does not come easily; teachers should be alert to the issues of culture in designing curriculum.

Predictors of obesity in school-aged Jordanian adolescents.

This cross-sectional study aimed to estimate the frequency of overweight and obesity in adolescents as defined by the International Obesity Task Force, and to estimate the effect of sociodemographic and health behaviours (eating habits and physical activity) that predict obesity. A stratified (by gender) random sample of 518 adolescents, aged 15 or 16 years was obtained from eight public schools in Amman. In this sample 17.5% were overweight and 9.6% were obese. The predictors of obesity and overweight (excess weight) were: (i) fathers attained primary and secondary education; (ii) total monthly family income > or = 300 (JD); (iii) working mothers; (iv) family size < or = 6; and (v) having obese parents. Eating a low quality diet (chips, candy) was a significant dietary predictor of excess weight. The family variables found to be important predictors along with a low quality diet suggest that family interventions would be necessary in the control of adolescent excess weight.

Factors contributing to adolescent obesity.

Obesity in children is a significant public health concern. The prevalence of overweight and obesity in Jordanian children, and adolescents has increased in the last decade. The consequences of obesity to health in childhood and adulthood have both medical, and economic cost to individuals and society. This paper reviews the factors that contribute to adolescent obesity and emphasizes behavioral and environmental factors. An individual's behaviors such as increased consumption of high caloric foods, increased sedentary activity while decreasing physical activity has been identified as key issues in the development of obesity. Additionally, the current environment in homes, schools, and neighborhoods tend to discourage a healthy lifestyle. A comprehensive approach that involves the whole community is the best strategy for preventing adolescent obesity. Nurses are in a unique position to provide leadership in developing programs for healthier lifestyle choices for adolescents' and adoption of these goals into their daily lives.