Mental health of clinic-attending Syrian refugee women in Jordan: associations between social ecological risks factors and mental health symptoms.

BACKGROUND: The mental health of refugee women is often affected by multiple risk factors in their social ecology. Assessing these risk factors is foundational in determining potential areas for intervention. We used the social ecological model to examine risk factors associated with self-reported mental health symptoms among clinic-attending Syrian refugee women in Jordan. We hypothesize that individual (older age, unmarried, have more children under 18, difficulty reading/writing with ease), interpersonal (intimate partner violence [IPV]), community and societal level risk factors (greater number of postmigration stressors), will be associated with depression, anxiety, and post-traumatic stress disorder (PTSD) symptoms. METHODS: We surveyed 507 women using a cross-sectional clinic-based systematic sampling approach between April and November 2018. We used multivariable regressions to examine associations between different risk factors in the social ecology on depression, anxiety, and PTSD. Additional multivariable regressions explored associations between specific postmigration stressors and mental health conditions. RESULTS: We found rates of depression among our sample to be 62.92%; anxiety 57.46%; and PTSD 66.21%. Our hypothesis was partially supported. At the individual level, age was directly associated with anxiety (aOR 1.04, 95% CI [1.02, 1.06]) and PTSD (aOR 1.03, 95% CI [1.01, 1.06]), while marriage decreased odds for depression (aOR 0.41, 95% CI [0.19, 0.92]) and PTSD (aOR 0.36, 95% CI [0.15, 0.87]). IPV was associated with depression (aOR 2.78, 95% CI [1.72, 4.47]); anxiety (aOR 3.30, 95% CI [2.06, 5.27]); and PTSD (aOR 5.49, 95% CI [3.09, 9.76]). Each additional community and societal risk factor (postmigration stressor) increased the odds for depression (aOR 1.32, 95% CI [1.22, 1.42]), anxiety (aOR 1.28, 95% CI [1.19, 1.39]), and PTSD (aOR 1.46, 95% CI [1.33, 1.60]). CONCLUSION: Understanding social ecological risk factors associated with mental health conditions of Syrian refugee women is vital to addressing their mental health needs. IPV and postmigration stressors are consistently impactful with all mental health conditions. IPV resulted in the largest odds increase for all mental health conditions. Multilevel interventions are needed to address mental health risk factors at multiple levels of the social ecology.

The Safety and Effectiveness of Infliximab Biosimilar in Managing Rheumatoid Arthritis: A Real-Life Experience from Jordan.

Background: Infliximab (IFX) biosimilar was the first biosimilar approved in Jordan in 2014, with limited evidence of its safety and effectiveness from the Middle East and North Africa (MENA) region. Thus, this study aimed to evaluate the safety and effectiveness of IFX biosimilar in active rheumatoid arthritis (RA) patients over 34 weeks by investigating (1) the adverse events (AEs), serious adverse events (SAEs), and therapy discontinuation and (2) the score changes of the 28-Joint Disease Activity Score (DAS28) and the Health Assessment Questionnaire Disability Index (HAQ-DI). Methods: This multicenter prospective cohort study collected clinical parameters within hospital settings every four weeks. The numbers and percentages of observed AEs and SAEs were informed. The DAS28 utilizing Erythrocyte Sedimentation Rate (ESR), HAQ-DI, and ESR were reported at baseline and 14th and 30th weeks; thus, they were reported as means (SD). Results: A total of 22 RA patients were enrolled and initiated IFX biosimilar, of which nine (41.0%) discontinued the study, but their data were analyzed up to the point of withdrawal. A total of 35 AEs were reported in 14 patients, including two (5.7%) SAEs. None of the participants discontinued treatment due to AEs. The mean (SD) score of DAS28-ESR significantly decreased from 6.55 (1.16) at baseline to 4.59 (1.45) at week 14 (p < 0.0001) and to 4.77 (1.09) at week 30 (p < 0.0001). Similarly, the mean (SD) HAQ-DI score significantly decreased from 0.95 (0.74) at baseline to 0.48 (0.62) at week 14 (p=0.008) and to 0.71 (0.78) at week 30 (p=0.483). The mean (SD) value of ESR decreased from 58.75 (26.94) at baseline to 47.92 (33.89) at week 14 (p=0.082) and to 39.83 (17.38) at week 30 (p=0.005). Conclusion: IFX biosimilar demonstrated safety and effectiveness in managing RA patients bringing real-world clinical support for biosimilars' role in rheumatology.

Knowledge and attitudes towards polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is a complex condition affecting about 5% to 7% of women in their reproductive years. Adequate knowledge and a right attitude play an important role in the management of the disease and in the prevention of complications. This study aimed to assess the knowledge and attitude of women towards PCOS. A questionnaire-based cross-sectional study was conducted in women aged 18-75 years old at the outpatient department of Jordan University Hospital. The questionnaire consisted of three main parts: the respondents' sociodemographic variables, knowledge of PCOS, and attitude towards PCOS. There was a total of 400 participants, data was analyzed using SPSS version 23, 89% of the 400 participants were aware of the term PCOS. Most of the participants have adequate knowledge and positive attitude towards the disease. However, most of them lack knowledge on its complications. The level of education and occupation were found to have a positive association with knowledge and attitude towards the disease. Meanwhile, marital status and age were only found to have a positive association towards knowledge. Doctors were found to be the most preferred source of knowledge for further information about PCOS.

Association of menopausal symptom severity and osteoporotic fractures: a case-control study.

AIM: to find out the association between the severity of different menopausal symptoms with the occurrence of osteoporotic fractures. METHODS: case-control study of 159 patients who suffered from osteoporotic fractures and 169 controls. Data collected using a pre-validated questionnaire of the Arabic version of Menopause rating scale, in addition to other sociodemographics. RESULTS: all menopausal symptoms were more severe in women in the control group, the highest scores were reported for joint pain followed by hot flashes. Conclusion severe menopausal symptoms are linked to less osteoporotic fracture, more randomized trials are needed to prove this association.

Patterns and severity of menopausal symptoms among Jordanian women.

We examined 359 women aged 45-65 years who visited Jordan University Hospital between February and November 2014. The menopausal symptoms were assessed using a validated Arabic version of the menopause rating scale. The mean age at menopause was 49.4 years. Women aged 50-55 years more frequently exhibited hot flushes and vaginal dryness. Although premenopausal women were 1.5 times more likely to experience irritability, perimenopausal women were more likely to experience hot flushes, physical and mental irritability, sexual problems, vaginal dryness, and joint and muscular discomfort. Hence, health care providers should focus on women at all stages of life.

Short course in evidence-based medicine improves knowledge and skills of undergraduate medical students: a before-and-after study.

BACKGROUND: Providing evidence-based care is recognized as a key skill for health care workers from diverse professions and cultures. PURPOSE: We aimed to assess the effectiveness of a short course in evidence-based medicine (EBM) to change the knowledge and skills of undergraduate medical students and point to possible incorporation of EBM in their curriculum. METHODS: This is a before-and-after study that was evaluated by the Fresno questionnaire. A 2-week short course of lectures, seminars, online search, and answering worksheets was conducted on 54 fifth-year medical students rotating through the family medicine department at Jordan University Hospital from September 1 until mid-December 2011. RESULTS: The students achieved a mean score of 26.7 out of 200 in the pretest and 119.5 in the posttest. The mean difference between the pre- and posttests was 92.8, a statistically significant result with a 95% confidence interval of 84.7, 101.0 (p<.0001) with an effect size of 4.2 standard deviation units. CONCLUSIONS: A short course in EBM will significantly improve the skills and knowledge of undergraduate medical students.

Prevalence and risk factors of urinary incontinence among Jordanian women: impact on their life.

We estimate the prevalence and type of urinary incontinence (UI), possible associated risk factors, and the impact of UI on women's social and psychological well-being. The sample consisted of women attending a family medicine clinic at Jordan University Hospital (JUH) who answered a self-administered questionnaire. More than one-third of the sample reported the presence of UI. Stress type was the most frequently reported risk factor, followed by mixed incontinence, then urge. Age, diabetes, chronic cough, parity, and hysterectomy were positively associated with the presence of UI. Incontinence caused low self-esteem in more than half of the women who experienced it.

Review of Clinical Equipoise: Examples from Oncology Trials.

BACKGROUND: The current standards that govern clinical research have been shaped over the years through many historical, social, and political events. The third principle of the Belmont Report, Justice, guides the scientific community toward the equal distribution of benefits and risks in research involving human subjects. Clinical equipoise is the status of genuine uncertainty by the investigator about the superiority of one treatment arm over the other. The term clinical equipoise was proposed to provide an ethical ground to conduct randomized controlled clinical trials. OBJECTIVE: The objective of this review is to provide the reader with an overview of the emergence of the term equipoise and its utilization in randomized controlled trials. METHODS: In the current review article, the major oncology clinical trials and relevant patents were reviewed for the application/utilization of clinical equipoise. RESULTS: The concept of clinical equipoise has been challenged, and different alternatives were proposed. Yet, these alternatives received numerous critiques and failed to fully replace equipoise. In addition, several patents related to anticancer agents tested in the described studies were examined. No specific reference was made as part of the patent to the status of clinical equipoise. Alternatively, a description of the study arms was provided. CONCLUSION: There is a need for revisiting the concept of equipoise and its suggested alternatives for its ethical essence while addressing related challenges.

Premenstrual syndrome: consultation sources and the impact on women's quality of life.

Introduction: The main aim of this study was to explore the sources of consultation that women seek during premenstural syndrome (PMS), and to establish the association between the severity of PMS and how it affects the quality of life. Methods: Cross sectional study of 179 female patients, using an Arabic validated version of the shortened premenstrual assessment form, and a 7-item quality of life questionnaire that was developed by the researchers. The questionnaire was tested for validity and reliability via a pilot study before the initiation of data collection. Data was analyzed using SPSS version 19. Results: 179 women participated in the study, with more than half of them aged between 20-30 years old. PMS prevalence was 88%; patient's predominantly sought help from their relatives (51%), followed by physicians (34%). There was no association found between the severity of premenstrual symptoms and seeking consultation. PMS symptoms affected women's daily activities (p-value 0.039), their satisfaction with their general appearance (p-value 0.001) and weight (p-value 0.022), and affected their relationships with family members (p-value 0.001) and other people (p-value 0.002). Conclusion: PMS is a common condition that affects women and their quality of life in several ways. Physicians and primary health care providers must be more vigilant in detecting the presence of PMS.

Risk factors for miscarriage in Syrian refugee women living in non-camp settings in Jordan: results from the Women ASPIRE cross-sectional study.

BACKGROUND: Syrian refugee women face health care disparities and experience worse pregnancy outcomes, including miscarriage. We investigated risk factors for miscarriage in Syrian refugee women living in non-camp settings in Jordan to identify targets for interventions. METHODS: We analyzed data from Women ASPIRE, a cross-sectional study of gendered physical and mental health concerns of 507 Syrian refugee women (≥ 18 years old) living in non-camp settings in Jordan. We recruited women using systematic clinic-based sampling from four clinics. We limited our analyses to women who had a history of pregnancy and whose most recent pregnancy was single, took place in Jordan, and ended in term live birth or miscarriage (N = 307). We grouped the women by the primary outcome (term live birth or miscarriage) and compared the sociodemographic and clinical characteristics of the two groups. We used Pearson's χ2 test or the Mann-Whitney U test to obtain unadjusted estimates and multivariable binomial logistic regression to obtain adjusted estimates. RESULTS: The most recent pregnancies of 262 women (85%) ended in term live birth and another 45 (15%) ended in miscarriage. Since crossing into Jordan, 11 women (4%) had not received reproductive health services. Of 35 women who were ≥ 35 years old, not pregnant, and did not want a (or another) child, nine (26%) did not use contraception. Of nine women who were ≥ 35 years old and pregnant, seven (78%) did not plan the pregnancy. The adjusted odds of miscarriage were higher in women who had been diagnosed with thyroid disease (aOR, 5.54; 95% CI, 1.56-19.07), had been of advanced maternal age (aOR, 5.83; 95% CI, 2.02-16.91), and had not received prenatal care (aOR, 36.33; 95% CI, 12.04-129.71). Each additional previous miscarriage predicted an increase in the adjusted odds of miscarriage by a factor of 1.94 (1.22-3.09). CONCLUSIONS: We identified several risk factors for miscarriage in Syrian refugee women living in non-camp settings in Jordan. The risk factors may be amenable to preconception and prenatal care.

Correction: Healthy lifestyle behaviors are major predictors of mental wellbeing during COVID-19 pandemic confinement: A study on adult Arabs in higher educational institutions.

[This corrects the article DOI: 10.1371/journal.pone.0243524.].

Awareness and perception of COVID-19 among the general population: A Middle Eastern survey.

Due to the sudden emergence of the novel coronavirus as a worldwide pandemic, this study aimed to evaluate the awareness and practices of both the Jordanian and Iraqi populations during the early stages of the pandemic. A cross-sectional survey was conducted between the 19th and 22nd of March to assess the public's awareness toward COVID-19. Multiple scored domains were used to assess the differences between the two populations. Statistical analysis was conducted to reveal the influence of sociodemographic variables on these scores. A total of 3167 participants were recruited in the study, of which, 1599 (50.5%) were from Jordan and 1568 (49.5%) were from Iraq. More than half of the Jordanian (56.8%) and Iraqi participants (53.2%) showed average or adequate awareness about COVID-19. More than 60% of both populations relied on medical staff for COVID-19 related information. Social media was the second most common COVID-19 information source, as it was reported by 53.7% of Jordanian participants and 62.8% of Iraqi participants. More than 90% of both populations participated in precautionary measurements. Finally, about 20% of both populations failed to recognize droplet inhalation as a source of transmission. Despite the portrayed awareness levels, governmental involvement is warranted to increase the public's awareness and fill the gaps within their knowledge.

Healthy lifestyle behaviors are major predictors of mental wellbeing during COVID-19 pandemic confinement: A study on adult Arabs in higher educational institutions.

BACKGROUND: In the past infectious diseases affected the quality of lifestyle during home confinement. The study conducted examines the influence of home confinement during the COVID-19 pandemic outbreak on lifestyle, mental wellbeing, nutritional status, and sleeping pattern. METHOD: An online multicategorical questionnaire was distributed to collect demographic information combined with the following tools: Food Frequency Questionnaire (FFQ), International Physical Activity Questionnaire (IPAQ), WHO-5 wellbeing score, and Pittsburgh Sleep Quality Index (PSQI). A snowball non-discriminate sampling procedure was conducted to collect data from people attending or working at higher institutions from March 1, 2020 to April 24, 2020. A total of 1723 completed responses (917 males, 37.4 ±13.4 years old and 806 females 32.2 ± 11.5 years old) were collected. RESULTS: The female participants had significantly lower mental health scores than males (53.9% vs. 46.1%). The mental wellbeing scores were higher among participants with medium and high physical activity (PA) levels (p < 0.00). Additionally, the mental wellbeing scores were significantly improved by dietary quality and it's sleeping score (p < 0.001). However, PA was by far the major determinant of the mental health scores. CONCLUSION: Factors such as PA, diet, and sleeping patterns were associated with mental wellbeing during the COVID-19 confinement among Arab participants.

Increased irisin versus reduced fibroblast growth factor1 (FGF1) in relation to adiposity, atherogenicity and hematological indices in metabolic syndrome patients with and without prediabetes.

Background Irisin and fibroblast growth factor 1 (FGF1) are intricately involved in metabolic syndrome (MetS) and prediabetes (preDM) pathophysiology. This study aimed to compare and correlate irisin and FGF1 plasma levels, adiposity, atherogenicity and hematological indices in 29 normoglycemic MetS and 30 newly diagnosed drug naive prediabetic (PreDM) MetS patients vs. 29 lean and normoglycemic controls. Materials and methods Irisin and FGF1 plasma levels were measured using colorimetric assays. Intergroup comparisons were conducted by analysis of variance (ANOVA). Spearman's rank correlation was also examined. Results The mean circulating irisin levels (ng/mL) were significantly higher in the normoglycemic (but not prediabetic) MetS group (p < 0.01), while the mean circulating FGF1 levels (pg/mL) were markedly lower in the prediabetic (but not normoglycemic) MetS group (p < 0.05). Of note unlike FGF1, irisin in the MetS (both normoglycemic and prediabetic;N=59) groups correlated significantly and positively with each of waist circumference (WC), hip circumference (HC), body mass index (BMI), body adiposity index (BAI) and high-density lipoprotein-cholesterol (HDL-C) but not the non-HDL-C. Distinctively MetS-irisin negatively associated with the non-HDL-C/HDL-C ratio, total cholesterol (TC)/HDL-C ratio and the low-density lipoprotein-cholesterol (LDL-C)/HDL-C ratio, but positively with the red cell distribution width (RDW). In the same pool of 59 MetS reruits; Neither biomarker had a relationship with the visceral adiposity index (VAI), the lipid accumulation product (LAP), the conicity index (CI), the waist-hip ratio (WHR), the waist-to-height ratio (WHtR), the blood ratios or the atherogenicity index of plasma (AIP). Conclusions As any potential molecular crosstalk of irisin and FGF1 in MetS or its related dysregularities cannot be ruled out; Conversely the utility of irisin and FGF1 as surrogate prognostic biomarkers and putative pharmacotherapeutic targets in the predtion/prevention/management of diabetes and MetS is strongly suggested.