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PubMed2003

Epidemiology and management of hypertension among Bedouins in Northern Jordan.

OBJECTIVE: To estimate the magnitude of hypertension, and its levels of awareness and control of hypertension among a community of Jordanian aborigines in Northern Jordan; and to compare the study findings with findings from other Jordanian communities. METHODS: A systematic sample of 50% of all households of Qafqafa, Northern Jordan was selected and all members of the selected households were included in the study at Qafqafa Health Center, Qafqafa, Jordan. A structured questionnaire was administered to all study participants and measurement of blood pressure was performed according to a preset criteria. Data on 366 subjects included in the sample were collected during the months of April and May 2002. RESULTS: A total of 40 subjects or 10.9% were suffering from hypertension. Prevalence rate of hypertension was significantly lower than the 16.1% and 16.3% prevalence rates reported from other more modernized Jordanian communities. Logistic regression analysis indicated that hypertension was positively associated with masculinity, age, illiteracy, obesity, and with positive family history of hypertension. No association was detected between hypertension and each of smoking, Diabetes mellitus, and total serum cholesterol. This study showed that one-half (47.5%) of hypertensives were unaware of their diagnosis and more than one-half (57.1%) of those aware of their diagnosis did not achieve control of their hypertension. CONCLUSION: Population of the study community has significantly lower levels of hypertension than both semi-urban and recently urbanized Jordanian communities, and much of the rise in blood pressure levels is attributed to environmental factors. Moreover, hypertension management programs in Jordan are far below the optimal standards.

Adult↗
PubMed2003

Prevalence of selected risk factors for chronic disease--Jordan, 2002.

In Jordan, the average life expectancy in 2002 was 72 years, and chronic diseases are becoming increasingly prevalent. Because personal behavior can influence the occurrence and progression of many chronic diseases, the Jordan Ministry of Health (JMoH) established surveillance for behavioral risk factors, particularly those related to cardiovascular diseases and diabetes. This report summarizes the key findings of the 2002 Behavioral Risk Factor Survey, the first reporting segment in Jordan's surveillance program for chronic diseases. The findings indicate that smoking, physical inactivity, and obesity contribute substantially to the burden of chronic disease in Jordan and underscores the need for effective public health interventions.

Chronic Disease↗
PubMed2004

Epstein-Barr virus expression in Hodgkin's disease in Jordan.

OBJECTIVE: Epstein-Barr virus (EBV) has been associated with many hematopoietic malignancies including Hodgkin's disease (HD). The association of HD correlates with the histologic subtype, age of presentation and geographic location. Our aims were to find out if EBV is associated with Jordanian HD; and if EBV association exists, to determine its relationship to certain age groups or specific histologic subtypes of HD; and finally to establish whether such association follows patterns seen in developing or developed countries. METHODS: We have examined 64 cases of HD diagnosed in 2 major medical centers in Jordan for evidence of EBV association. We used immunohistochemistry and in-situ hybridization techniques to detect latent membrane protein (LMP-1) and Epstein-Barr virus encoded RNA (EBER) in the Reed-Sternberg cells. The study was conducted at the Department of Pathology, Jordan University of Science and Technology, Irbid, Jordan in the years 2000 and 2001. RESULTS: Epstein Barr virus was seen in 47% of our cases: 22 (65%) of the 34 mixed cellularity and 8 (29%) of 28 nodular sclerosis HD. None of our 2 lymphocyte predominant HD cases showed evidence of EBV. Epstein-Barr virus was seen in 73% of HD cases in children below 15 years of age as opposed to 34% of the young adult group. CONCLUSION: Our results confirm the presence of EBV in Jordanian HD in approximately half of the cases, a figure close to those reported in the West. Epstein-Barr virus association with HD in Jordan is seen mostly in the mixed cellularity subtype and childhood HD.

Adolescent↗
PubMed2004

Male breast disorders in Jordan. Disease patterns and management problems.

OBJECTIVE: To highlight the features and management problems of male breast disorders in an eastern country such as Jordan. METHODS: Data regarding 33 male patients who underwent surgery for breast diseases in the Department of Surgery at Jordan University of Science and Technology, Irbid, Jordan, between the year 1996 and 2002 were analyzed. RESULTS: Gynecomastia (45.5%), ductal carcinoma (18.2%), and lipoma (12.1%) were the most frequent lesions. Endocrine testing when the clinical diagnosis was physiologic gynecomastia was not yielding. Many features of male breast carcinoma in Jordan (symptomatology, male to female ratio, high education rate, age, diagnostic yield of fine-needle aspiration, histological type, and estrogen receptor status) did not depart from the experience of others. Delayed presentation is evident from the fact that 57% of tumors were stage III. Loco-regional control was achieved by modified radical mastectomy. Tamoxifen was used in 5 patients, and chemotherapy in 4 patients. The patient with stage I is still disease free 6 years after the diagnosis. The 5-year survival rate for stages II and III was zero. Rare lesions (cystic hygroma, cystic mastopathy, fibroadenoma, duct papilloma, tuberculosis, periductal mastitis, and the previously unreported primary primitive neuroectodermal tumor of the breast) accounted for the rest of the group. The patient with primary primitive neuroectodermal tumor of right breast was treated by mastectomy and adjuvant chemotherapy. He remains disease free 31 months after the diagnosis. CONCLUSION: Unawareness and the fact that male breast enlargement is considered a social stigmata are responsible for the delayed presentation. The value of fine needle aspiration cytology and mammography is not widely appreciated. The wide spectrum of potential pathologies calls for referring all patients to specialized breast units.

Adolescent↗
PubMed2006

New trends in the clinicopathological features of differentiated thyroid cancer in Central Jordan.

OBJECTIVE: To investigate the current trends in presentation and distribution of differentiated thyroid cancer (DTC) at the largest referral hospital for endocrine cancers in Central Jordan. METHODS: We analyzed the clinical features, management and outcome of 110 patients diagnosed with thyroid carcinoma at Jordan University Hospital, Amman, between 1996 and 2001. RESULTS: Papillary carcinoma was diagnosed in 87 patients (80%), follicular carcinoma in 3 patients (2.7%), Hurthle cell carcinoma in 8 patients (7.3%), medullary carcinoma in 5 (4.5%), and anaplastic carcinoma in 4 patients (3.6%), metastatic cancer in 2 patients and lymphoma in one patient. Time course analysis showed an increasing trend in surgery for thyroid cancer from 28 cases in 1986-1991 to 48 in 1996-2001. As time advanced, the incidence of locally invasive disease and lymph node involvement markedly increased over the last 5 years of the study (from 28-62%). All patients with follicular carcinoma were diagnosed in the period 1986-1994. After thyroidectomy and a follow up period of 2-15 years, 10 patients died of their disease, 4 of these died within one year from anaplastic thyroid carcinoma. CONCLUSION: The dramatic decline in the incidence of follicular thyroid carcinoma combined with the increase in the advanced forms of thyroid cancer in Central Jordan may suggest a possible environmental factor in thyroid carcinogenesis in this region. We suggest a larger scale studies and steps to investigate the etiologic factors for thyroid carcinogenesis in Central Jordan.

Adult↗
PubMed2006

Assessing risk factors for chronic disease--Jordan, 2004.

In 2003, chronic diseases were the leading cause of mortality in Jordan; 38.2% of deaths were attributed to cardiovascular disease and 14.3% to cancer (Jordan Ministry of Health [MOH], unpublished data, 2004). In 2002, MOH, with assistance from CDC and the World Health Organization (WHO), established a behavioral risk factor surveillance program to monitor risk factors associated with chronic diseases. This report summarizes the findings of the second Behavioral Risk Factor Survey, which was conducted in Jordan in 2004. The findings indicated that the prevalence of obesity had increased by 52.3% in Jordan since 2002. In addition, cancer screening rates among women and seatbelt use rates overall were low compared with U.S. rates. Development and implementation of a national plan to prevent and control chronic diseases is needed.

Behavioral Risk Factor Surveillance System↗
PubMed1978

[Seroepidemiological investigations in domestic ruminants from Egypt, Somalia and Jordan for the demonstration of complement fixing antibodies against Rickettsia and Chlamydia (author's transl)].

1450 random serum samples of domestic ruminants from Egypt, Somalia and Jordan were investigated for complement fixing antibodies against Rickettsia and Chlamydia. Between 1.5 and 3.4% of the samples from the animals investigated had antibodies against the RMSF-group of Rickettsia, with exception of the sera from Somalian cattle and sheep from Jordan. Antibodies against Rickettsia of the Typhus-group were found in 4 cattle and 1 goat from Jordan and 2 sheep from Egypt; by agglutination test with type-specific antigen they were identified as antibodies against R. typhi. Using 2 different antigens, antibodies against Coxiella burnetii were found in every population tested. The prevalence was 2.0 to 12.2%, with the exception of cattle in Somalia, where only 1 positive serum (0.2%) was found. 27% of the serum samples from Jordan and 22% from Egypt but none of the 802 samples from Somalia had antibodies against Chlamydia. The results are discussed under an epidemiological point of view.

Animals↗
PubMed2000

PROFILE: Protected Area Management in Jordan.

/ Protected area management is increasingly important throughout the world, particularly in less developed countries and arid regions. The Middle East, includingJordan, has important and unique resources due to its varied topography and climate. In Jordan, the protected areas are privately, rather than publicly, managed, and this provides for a unique and somewhat challenging management effort. The purpose of this paper is to review the establishment and administration of Jordan's protected areas with particular emphasis on the challenges of multiple administrative and legislative layers, departmental working relationships, and a paucity of funding. Interviews with government and nongovernmental experts in Jordan, coupled with a review of pertinent academic and planning literature, served as the information base for this study. Despite new legislative and administrative initiatives, results reveal important and continuing challenges for Jordan. Recommendations include completion of protected area inventories, government wide institutional strengthening, partnering with organizations and the public, as well as legislative reexamination.

Journal Article↗
PubMedDate not supplied

The spatial distribution of enteric bacteria in the Jordan River-Lake Kinneret contact zone.

Lake Kinneret, in the north of Israel, is the only freshwater body in the country. It supports many activities, including recreation, tourism, and a commercial fishing industry, but its prime function is to supply water to other parts of the country. Consequently, maintaining a high water quality of the lake is of prime importance. The major part (some 90%) of the annual runoff of water enters Lake Kinneret from the north via the Jordan River during the autumn-winter floods. During this period, the river carries sediments, toxic agricultural chemicals, and allochthonous organisms, including pathogenic bacteria, into the lake. The Jordan River-Lake Kinneret contact zone is characterized by a rapid transformation from a riverine to a lacustrine water mass within 700 m from the river mouth, with very high spatial gradients of practically all hydrodynamic, hydrophysical, hydrochemical, and microbiological parameters. Previous measurements have shown that the distribution of enteric bacteria in the river-lake contact zone is related to the attenuation of river current flows. The aim of this study was to determine whether the change in the number of enteric bacteria (fecal coliforms, Escherichia coli, and Klebsiella spp.) in the water of the River Jordan-Lake Kinneret contact zone was due to sedimentation or to dilution. The data were then utilized to build a conceptual model explaining the distribution of biological pollutants (bacteria) in the river-lake contact zone of a shallow tropical lake, using the microbial communities of the River Jordan-Lake Kinneret contact zone, as an example.

Enterobacteriaceae↗
PubMed2004

Survey of attitudes, materials and methods employed in endodontic treatment by general dental practitioners in North Jordan.

BACKGROUND: General dental practitioners provide the majority of endodontic treatment in Jordan. The aim of this study was to gather information on the methods, materials and attitudes employed in root canal treatment by dentists in North Jordan, in order to evaluate and improve the quality of current practice. METHODS: A questionnaire was posted to all registered general dental practitioners working in private practice in Irbid Governate in North Jordan (n = 181). The questionnaire included information on methods, materials and techniques used in endodontic treatment. RESULTS: Reply rate was 72% (n = 131). The results demonstrated that only five dentists used rubber dam occasionally and not routinely. The majority used cotton rolls for isolation solely or in combination with a high volume saliva ejector (n = 116). The most widely used irrigants were sodium hypochlorite and hydrogen peroxide, which were used by 32.9% (n = 43) and 33.6% (n = 44) of the respondents, respectively. Forty eight percent of the respondents (n = 61) used the cold lateral condensation technique for canal obturation, 31.3% (n = 41) used single cone, 9.9% (n = 13) used vertical condensation and 12.2% (n = 16) used paste or cement only for the obturation. The majority used zinc oxide eugenol as a sealer (72.5%). All, but one, respondents used hand instruments for canal preparation and the technique of choice was step back (52.7%). More than 50% (n = 70) of the dentists took one radiograph for determining the working length, whilst 22.9% (n = 30) did not take any radiograph at all. Most practitioners performed treatment in three visits for teeth with two or more root canals, and in two visits for teeth with a single root canal. CONCLUSIONS: This study indicates that dentists practicing in North Jordan do not comply with international quality standards and do not use recently introduced techniques. Many clinicians never take a radiograph for determining the working length and never used rubber dam or intra-canal medicaments.

Journal Article↗
PubMedDate not supplied

The incidence of childhood cancer in Jordan: a population-based study.

BACKGROUND: Marked variations in the incidence of particular types of childhood cancer exist between countries. We report on the geographic variation in the occurrence of childhood cancer in Jordan. MATERIAL AND METHODS: Cases were identified from the Jordan National Cancer Registry. We collected data on age, sex, type, primary site, and stage of cancer. Tumor topography and morphology were coded according to the accepted international standard. For all cases registered, 95.2% were histologically diagnosed. Incidence rates were calculated as annual rates per million population. The denominator is the 1997 estimate of the childhood population at ages 0-4, 5-9, and 10-14 years. RESULTS: There were 646 registered primary malignant neoplasms during the three-year study period (1996-1998). The annual incidence rate for all types of cancer combined was 113 per million children. The rate among children less than 5 years of age was 134.5 per million, for 5-9 years it was 97.8 per million, and for 10-14 years it was 104.1 per million. Overall, the age-standardized annual incidence rate was 113.8 per million. The most common diagnostic group was leukemia, accounting for more than a third of all cases, followed by brain tumors and lymphoma. The highest rate was in the capital, Amman. CONCLUSION: The pattern of childhood cancer in Jordan seems to be generally similar to other countries in the region, particularly the observed excess of lymphoma. Geographical variations in childhood cancer exist in Jordan and could be partly explained on the basis of lower detection or reporting, or both, in certain locations.

Journal Article↗
PubMed2001

Spectrum of beta-thalassemia in Jordan: identification of two novel mutations.

Two hundred and forty-four beta-thalassemia alleles were identified from 135 unrelated occasionally and periodically transfusion dependent beta- and S/beta-thalassemia patients from all regions of Jordan. Allele identification was achieved by PCR amplification of beta-globin genes, dot-blotting the amplified DNA, hybridization with allele specific synthetic probes, and direct sequencing of amplified genomic DNA. A total of 19 different mutations were detected, eight of them constituted about 86% of the Jordanian thalassemic chromosomes. These mutations were IVS1-110 (G>A) (25%), IVS2-1 (G>A) (15%), IVS2-745 (C>G) (14.2%), IVS1-1 (G>A) (10%), IVS1-6 (T>C) (8.3%), codon 37 (G>A) (6.3%), codon 39 (C>T) (4.6%), and codon 5 (-C) (3.8%). The remaining eleven mutations were rare, presented with frequencies ranging between 0.4% and 1.6%. These included two novel mutations and four others detected in Jordan for the first time. The novel mutations were the frame shift (-C) at codon 49 and the substitution (A>C) at position -29 in the TATA box. Four alleles (1.6%) remained unidentified; having no abnormalities in their beta-globin gene sequences and therefore, constituted additional defects causing beta-thalassemia in the Jordanian population. These unknown alleles are expected to be candidates for upstream or downstream mutations affecting the expression of beta-globin gene. The results provided the essential foundation for planning a national preventive program for thalassemia in Jordan and will help improving the medical services for the patients and their families by helping their clinicians and genetic counselors in evaluating their variants and designing their treatment regimens.

Alleles↗
PubMed1993

Hereditary thrombophilia among 217 consecutive patients with thromboembolic disease in Jordan.

This is a four-year prospective study on patients admitted or referred with thromboembolic disease to Jordan University Hospital or to the Thrombosis/Haemostasis Laboratory at the University of Jordan. The aim of the study was to find the relative prevalence of hereditary thrombophilia. For the purpose of this work, hereditary thrombophilia was diagnosed in the absence of an acquired cause of thrombophilia in addition to two of the following: 1) positive family history of thrombophilia, 2) confirmed same deficiency in a closely related family member, 3) the deficient protein is constantly below 2 SD of the normal mean on repeated testing. All ages were admitted to the study. Acquired systemic factors or local factors known to cause thrombosis or affect the levels of proteins opposing thrombosis were excluded. There were a total of 217 patients (102 males and 115 females) with confirmed thromboembolic disease. Their mean age was 34 years. A total of 49 patients (26 males and 23 females) fulfilled the criteria of hereditary thrombophilia. There were 17 cases of protein C deficiency (PC), 15 protein S deficiency (PS), 10 antithrombin III deficiency (ATIII), 3 dyfibrinogenemia, 2 heparin cofactor II deficiency, and 2 plasminogen defects. In this group most of the thrombosis was venous. A positive family history was obtained in 65.3% of patients with hereditary thrombophilia. Twenty-seven additional relatives with deficiency were identified upon family studies. The calculated prevalence of hereditary thrombophilia in Jordan is put at 1/25,000. Screening for PC, PS, and ATIII is advocated in young patients who have thromboembolic disease, especially when there is a positive family history of thrombosis.

Adolescent↗
PubMed2001

Reasons for placement and replacement of amalgam restorations in Jordan.

AIMS: To record the reasons for placement and replacement of amalgam restorations in Jordan, to determine the use of amalgam restorations in common cavity types and to collect data on the age of the replaced amalgam restorations. SUBJECTS AND SETTING: Dentists in Jordan (n=241). METHOD: Cross-sectional study using postal survey backed up with personal contact. Data was recorded for all restorations placed or replaced over a period of one month. RESULTS: Information was collected on 3,166 restorations from patients aged 9 to 66 years. Of all restorations, 54.8% were first time placements while 45.2% were replacements of old restorations. The major reason for the first time restorations was primary caries, while that for replacement was secondary caries (28.5%) followed by broken and lost restorations (20.4%), root canal therapy (17%), tooth fracture (12%), pain or sensitivity (8.8%), poor margins (8.5%). CONCLUSIONS: In Jordan, the main reason for first placement of amalgam restoration is primary caries, the main reason for replacement is secondary caries.

Adolescent↗
PubMed1994

Application of Smeed's formula to assess development of traffic safety in Jordan.

Traffic safety in Jordan has been debated in the last few years. A high percentage of the citizens still think that the country is ranked among the most dangerous countries in the world. This study traces the development of traffic safety in Jordan during the last two decades. Examining changes in accident rate over time and comparing with those in Middle Eastern and developing countries, it is concluded that safety levels in Jordan are among the best in Middle Eastern and developing countries.

Accidents, Traffic↗
PubMed2005

Public response to chest pain in Jordan.

BACKGROUND: Chest pain is one of the main and most frequent manifestations of myocardial infarction (MI). Increased level of public awareness on the optimal response to chest pain due to MI attacks is crucial for minimizing its complications and mortality rate. AIMS: The first aim of this investigation was to assess the level of public awareness on their response to acute chest pain. The second aim was to obtain information about self-reported risk factors for coronary heart disease and acute myocardial infarction. SETTINGS AND DESIGN: This survey was conducted in various regions of Jordan during the period of July-September 2004. A total of 4194 adults (out of 4500), 2086 males (49.7%) and 2108 females (50.3%) resident in Jordan were included in the sample. The response rate was 92.3%. METHODS: Each individual of the sample who agreed voluntarily to participate in the investigation was asked to report in a questionnaire his/her possible risk factors for MI. Moreover, each person of the sample was asked "What do you do when you suffer from a severe and crushing chest pain that persists for longer than 15 min and radiates to jaws, neck or left shoulder, with sweating and paleness of the face?" The person was asked to choose one option out of 11. STATISTICAL ANALYSIS: The frequency and percentage were determined for each investigated parameter. RESULTS AND CONCLUSION: The highest percentage of respondents had good response by selecting the option "I go to a doctor" while the lowest percentage of respondents showed poor response by choosing the option "I use an antacid". The remainder of responses was distributed among other options. Excellent awareness was reported by 47% of the sample. Differences in the type of responses were detected when the results were analyzed according to gender, type of job, level of education and ethnicity. Approximately half of the interviewed individuals of the sample had 2-4 clustering risk factors for developing acute MI attacks. Individuals in more than half of the sample had family history of hypertension and diabetes mellitus. It is concluded that although the type of response to chest pain in Jordan is good-excellent, more improvement is recommended since the risk to MI is relatively high. Community education campaigns may participate in increasing public health education on the optimal response to chest pain of myocardial origin.

Acute Disease↗
PubMed2006

Awareness of physicians in Jordan about the treatment of high blood pressure according to the seventh report of the Joint National Committee (JNC VII).

BACKGROUND: Control of blood pressure remains suboptimal worldwide. High rates of undiagnosed and untreated hypertensive patients raise the need of searching for the basis of this situation among prescribing physicians. AIM: To evaluate the awareness of medical residents and practicing physicians in Jordan about the treatment of high blood pressure according to the seventh report of the Joint National Committee (JNC VII). METHOD: A written questionnaire was distributed to 200 physicians from different areas of Jordan during the period from November 2005 till February 2006. Recruitment of physicians in this study was in general, military, private hospitals and in clinics. A rigorously developed questionnaire on changes seen in JNC VII, target blood pressure goals, and the treatment of high blood pressure options was administered by trained medical personnel. RESULTS: One hundred and forty five physicians (72.5%) consented to complete the questionnaire. The practices of recent graduates from medical school were not better than those of older graduates. As a general rule, physicians in Jordan under treat high blood pressure. CONCLUSION: Our findings highlight the need for the revision of the teaching curricula in medical schools with regard to the management of hypertension, as well as the initiation of a widespread and intensive continuing medical education for all physicians involved in the management of patients with hypertension. Particular efforts are needed to encourage the use of low-cost thiazides and the use of angiotension converting enzyme inhibitors in heart failure patients and other compelling indications.

Adult↗
PubMed2006

Midwifery students' enrolment reasons and evaluations of the first Bachelor of Midwifery programme in Jordan.

OBJECTIVE: to explore reasons for enrolment in the first bachelor of midwifery programme in Jordan, and to describe midwifery students' evaluations of the programme. DESIGN: a cross-sectional survey design. SETTING: The Faculty of Nursing at Jordan University of Science and Technology, Irbid, Jordan. PARTICIPANTS: 16 diploma-prepared midwifery students enrolled in the 2-year bachelor-completion programme. MEASUREMENTS AND FINDINGS: an open-ended question explored students' reasons for enrolling in the midwifery programme. For programme evaluation, a 13-item Midwifery Programme Evaluation Questionnaire (MPEQ) was developed and used. Total score ranged from 39-61, with a mean of 51.2 (SD=6.7). CONCLUSION: midwifery students reported five reasons for enrolling in the midwifery programme, which was favourably evaluated. IMPLICATIONS FOR PRACTICE: encouragement and sustainability of student enrolment in the JUST Bachelor of Midwifery programme are recommended to improve midwifery education and enhance midwifery as a profession.

Adult↗