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Cross-national study of attitudes towards seeking professional help: Jordan, United Arab Emirates (UAE) and Arabs in Israel.

BACKGROUND: Help-seeking processes provide critical links between the onset of mental health problems and the provision of professional care. But little is known about these processes in the Arab world, and still less in transnational, comparative terms. This is the first study to compare help-seeking processes among Muslim Arab female students in Jordan, the United Arab Emirates and Israel. AIMS: The present study compares the attitudes of Arab Muslim female students from Israel, Jordan and the United Arab Emirates (UAE) towards mental health treatment. METHOD: A convenience sample of 262 female Muslim-Arab undergraduate university students from Jordan, United Arab Emirates (UAE) and Arab students in Israel completed a modified Orientation for Seeking Professional Help (OSPH) Questionnaire. RESULTS: Data revealed that nationality was not statistically significant as a variable in a positive attitude towards seeking professional help; year of study, marital status and age were found to be significant predictors of a positive attitude towards seeking help. High proportions of respondents among the nationalities referred to God through prayer during times of psychological distress. CONCLUSIONS: The discussion considers implications for professional service delivery and programme development. Future research could extrapolate findings to other Arab countries and to Arab peoples living in the non-Arab world.

Adaptation, Psychological↗

Immunohistochemical evaluation of human epidermal growth factor receptor 2 and estrogen and progesterone receptors in breast carcinoma in Jordan.

INTRODUCTION: Although breast carcinoma (BC) is the most common malignancy affecting Jordanian females and the affected population in Jordan is younger than that in the West, no information is available on its biological characteristics. Our aims in this study are to evaluate the expression of estrogen receptor (ER) and progesterone receptor (PR) and Her-2/neu overexpression in BC in Jordan, and to compare the expression of these with other prognostic parameters for BC such as histological type, histological grade, tumor size, patients' age, and number of lymph node metastases. METHOD: This is a retrospective study conducted in the Department of Pathology at Jordan University of Science and Technology. A confirmed 91 cases of BC diagnosed in the period 1995 to 1998 were reviewed and graded. We used immunohistochemistry to evaluate the expression of ER, PR, and Her-2. Immunohistochemical findings were correlated with age, tumor size, grade and axillary lymph node status. RESULTS: Her-2 was overexpressed in 24% of the cases. The mean age of Her-2 positive cases was 42 years as opposed to 53 years among Her-2 negative cases (p = 0.0001). Her-2 expression was inversely related to ER and PR expression. Her-2 positive tumors tended to be larger than Her-2 negative tumors with 35% overexpression among T3 tumors as opposed to 22% among T2 tumors (p = 0.13). Her-2 positive cases tended to have higher rates of axillary metastases, but this did not reach statistical significance. ER and PR positive cases were seen in older patients with smaller tumor sizes. CONCLUSION: Her-2 overexpression was seen in 24% of BC affecting Jordanian females. Her-2 overexpression was associated with young age at presentation, larger tumor size, and was inversely related to ER and PR expression. One-fifth of the carcinomas were Her-2 positive and ER negative. This group appears to represent an aggressive form of BC presenting at a young age with large primary tumors and a high rate of four or more axillary lymph node metastases.

Adult↗

Human and animal brucellosis in Jordan between 1996 and 1998: a study.

Between 1996 and 1998, a total of 2,494 samples of blood from humans and animals were collected and tested for brucellosis. This total included 1,594 samples of animal blood, collected from 1,050 sheep from 20 flocks, and 544 goats from eight herds. The serum samples were tested using the Rose Bengal test, the tube agglutination test, the complement fixation test and an enzyme-linked immunosorbent assay. Moreover, a complete history was compiled from each flock/herd. The rate of abortions in sheep due to brucellosis ranged from 0.5% to 56%, with a mean of 33.2%. The goats had a higher abortion rate. Thirty-four aborted sheep foetuses collected from these 20 flocks were bacteriologically and pathologically examined. A pure culture of Brucella melitensis biotype 3 was isolated from 21 of the aborted foetuses. The human blood samples were collected from two groups: first, from 800 apparently healthy people who were reporting to community hospitals for routine health checks and secondly, from 100 people from groups with a high-risk of contracting brucellosis, such as veterinarians, sheep-herders and laboratory technicians. The Brucella antibody titres for the 900 human serum samples were obtained using the microtitre agglutination test. The cumulative percentage of the serum samples showing a titre reading greater than 1:80 was higher in the at-risk group than among the normal population (7% compared to 4.1%). Although these results were not statistically significant, the higher percentage of positive reactors among the high-risk group may indicate an increased risk factor among professional agricultural and veterinary personnel in Jordan. It was concluded that brucellosis is common in sheep and goats in Jordan, subjecting the human population to high risks. Brucella melitensis Rev. 1 vaccination has been internationally recognised as the key to successfully controlling the disease. All animals in Jordan were repeatedly vaccinated between 1996 and 1998 on a trial basis, using a reduced dose of 1 x 10(5) colony-forming units (CFU). Cumulative data on the annual rate of human cases of brucellosis indicate that fewer people are affected each year. The same is true for the rate of abortions in animals. Such evidence strongly suggests that the vaccination programme has been successful. However, as wild strains of Brucella have also been isolated from vaccinated animals, the authors recommend increasing the amount of vaccine to a full dose of 1 to 2 x 10(9) CFU and vaccinating young female animals between the ages of three and eight months. To avoid brucellosis in humans, people should be educated about the dangers of contact with infected animals and the consumption of raw milk and milk products.

Abortion, Veterinary↗

Dyspepsia in the general population in Jordan.

OBJECTIVE: To assess the prevalence of dyspeptic symptoms in the general population of Jordan. METHODS: We selected families of final year students at the two medical schools in Jordan to represent the general population. The students were instructed to complete questionnaires for all their family members and all members of the close family above the age of 15 years living in the area. The questionnaire enquired about dyspeptic symptoms in the previous 12 months. Information about any chronic disease, medications used frequently, previous operations and cigarette smoking was obtained. RESULTS: Of 2254 completed questionnaires, dyspeptic symptoms were reported in 1354 (60.1%) during the previous 12 months. Heartburn was present in 1111 (49.3%), abdominal distension in 1224 (54.3%), recurrent abdominal pain with ulcer-like characters in 450 (20%), discomfort following meals in 316 (14%), symptoms related to fatty foods in 359 (15.9%) and symptoms related to ingestion of lactose-containing foods in 96 (4.3%). CONCLUSION: Dyspeptic symptoms are highly prevalent in Jordan. This may have an impact on the economy and health resources.

Adolescent↗

Mass psychogenic illness following tetanus-diphtheria toxoid vaccination in Jordan.

In September 1998, more than 800 young people in Jordan believed they had suffered from the side-effects of tetanus-diphtheria toxoid vaccine administered at school; 122 of them were admitted to hospital. For the vast majority, their symptoms did not result from the vaccine but arose from mass psychogenic illness. The role played by the media, the children's parents, and the medical profession in the escalation of this mass reaction appeared, at first sight, to be unusual and even unique to the circumstances in Jordan at the time. A review of the literature showed, however, that this mass reaction was similar in many ways to previous outbreaks, even though the underlying causes varied. There are about 200 published accounts of mass responses to situations involving suspected poisoning or other events. Because such mass reactions are relatively rare and the triggers so diverse, individuals faced with responding to them are unlikely to have prior experience in how to handle them and are unlikely to take bold steps to prevent their escalation. Indeed they may be unaware that such events have been recorded before. The lessons learned from this incident in Jordan may help other immunization programme managers to handle crisis situations elsewhere.

Adolescent↗

Evaluation of drug use in Jordan using WHO prescribing indicators.

Patterns of prescribing and use of pharmaceuticals by physicians and patients in Jordan have not previously been studied. We retrospectively evaluated pharmaceutical drug prescribing practices in 21 primary health care facilities in Irbid governorate, northern Jordan using World Health Organization-recommended core indicators. The mean number of drugs prescribed was 2.3 overall, ranging from 1.9 to 3.0. The percentage of drugs prescribed by generic name was very low, as was the percentage of prescriptions involving injections. The percentages of prescriptions involving antibiotics and drugs from the essential drugs list averaged 60.9% and 93% respectively. We conclude that the prescribing and use of drugs in Jordan requires rationalization, particularly the over-prescribing of antibiotics and the under-prescribing of generic drugs.

Adult↗

Evaluation of drug use in Jordan using WHO patient care and health facility indicators.

We prospectively studied current drug use in Jordan in 21 primary health care facilities in northern Jordan over a three-month period, using World Health Organization-recommended indicators. Both the mean time spent on physician-patient consultations (3.9 +/- 3.5 minutes) and mean pharmacy dispensing time (28.8 +/- 23.7 seconds) were short, resulting in a mean patient knowledge of prescribed drug dose of 77.7%. No centre had an essential drugs list and/or formulary available. An average of 80% of key drugs were available at centres. Baseline data gathered by this study can be used by researchers and policymakers to monitor and improve pharmaceutical prescribing and consumption practices in Jordan.

Drug Prescriptions↗

Maternal mortality in Mafraq District in Jordan.

The present study followed a multidimensional approach to determine maternal mortality ratio in Mafraq district in Jordan. It included active case (maternal deaths) surveillance combined with Civil Registry and hospital records review. Mafraq, by virtue of its geographic and demographic characteristics, is supposed to have a very high toll of maternal deaths and hence, generalizations reflecting the maximum expected maternal mortality ratio in Jordan could be made. The ratio, and as an average for the five years 1987-1991 covered in retrospect by the study was 42 deaths per 100,000 live births, very close to the estimated one. Establishing a baseline maternal mortality ratio and outlining risks pertaining to maternal survival as done in this study is an important prerequisite for interventions to reduce these risks and monitor progress towards reduction of maternal mortality ratio by half by the year 2000 which is a global goal to which Jordan is committed. The multidimensional approach followed by this study is shown to be superior to single source approaches in determining maternal mortality ratio in instances where populations are small and death registration is weak. The study suggests that maternal deaths (preferably as circumstances around the death and not as ICD coded, to avoid under reporting) should be reported in the same manner as notifiable diseases until improvements in death registration are completed and registries are accurate and valid.

Adolescent↗

Maternal health care utilization in Jordan: a study of patterns and determinants.

This article analyzes the patterns and determinants of maternal health care utilization in Jordan, using data from the Jordan Fertility and Family Health Survey of 1983. The study focuses on the 2,949 women who had a child in the five years preceding the survey. Through multivariate analyses of differentials in the utilization of prenatal care and health care at delivery, the study assesses the effect of sociodemographic factors, including residence, education, parity, and standard of living. The coverage of maternal health care in Jordan is discussed in relation to the overall organization of health services, the various providers of care, and the role of cultural factors.

Adolescent↗

[Scorpions and scorpion stings in Jordan].

The scorpion fauna of Jordan consists of fourteen species belonging to three families (Buthidae, Scorpionidae and Diplocentridae), of which three species are poisonous: Leiurus quinquestriatus, Adroctonus crassicauda and Buthus occitanus. A key to all species is included. Five hundred and forty-seven cases of scorpion stings were reported during 1982-1985, including two fatalities. Clinical data for sixteen cases treated at the Jordan University Hospital are summarized. In Jordan human and cultural customs are related to scorpion stings. Sting accidents according to age groups and seasons are given.

Adolescent↗

The changing epidemiology of diphtheria in Jordan.

Outbreaks of diphtheria used to occur regularly in Jordan, the last such outbreak being in 1977-78. Since that time, a massive immunization programme targeted at pre-school-age children has been markedly successful. Hence, when an outbreak of diphtheria occurred in 1982-83, it was unexpected. Of the 35 patients who were treated at the Jordan University Hospital, two died and the remaining 33 recovered uneventfully. Contrary to our findings in previous diphtheria epidemics in Jordan, this outbreak largely involved adolescents and young adults.

Adolescent↗

Cancer patterns in Jordan 1975-1979.

A total of 3,604 primary malignant tumours diagnosed histologically at the Departments of Pathology in Jordan during the period 1975-1979 were analysed. The relative frequency by age, sex and site of these tumours and age-standardised incidence rate are presented. Truncated standardised incidence rates for selected tumours were compared in Jordan and other countries. Except for the urinary bladder tumours, there is a striking resemblance between Jordan and other Middle Eastern countries in the pattern of tumour-occurrence in most sites. Skin malignancies are the dominant tumours in the general and male population, breast in female population and lymphomas in children. Noteworthy are the histologically advanced bladder cancers and the relatively young females affected by breast cancer at first diagnosis. Childhood tumours comprised 7.4% of the total cancers in the present study.

Adolescent↗

Primary gastrointestinal lymphomas in Jordan are similar to those in Western countries.

It has been a common practice to divide gastrointestinal (GI) lymphomas into Western and Middle Eastern types; the former predominantly involves the stomach, whereas the latter are mostly intestinal. Recent studies suggested that these lymphomas are biologically different from their nodal counterpart and hence should be classified separately. In this retrospective study, we examined all of the primary GI lymphomas seen at Jordan University Hospital, Amman, Jordan, between 1983 and 1992 in an attempt to reclassify and immunophenotype these cases. We studied 53 cases of primary GI lymphomas for which available material was found. Lymphomas were morphologically reclassified according to current classification schemes. Immunoperoxidase stains were performed using the streptavidin biotin method using antibodies against leukocyte common antigen, B, and T-cells. The stomach was the most common site of involvement, accounting for 62% of the cases. The male-to-female ratio was 2.8:1. The three most common histologic types were, in order, diffuse large cell lymphoma, Burkitt's lymphoma, and lymphoma of mucosa-associated lymphoid tissue. Immunoproliferative small intestinal disease was seen in only one patient. The B-cell phenotype predominated in our cases; it was seen in 85% of the gastric and 100% of the intestinal cases. Unlike other series from the region, the stomach was the most commonly involved site by GI lymphoma. Immunoproliferative small intestinal disease seems to be a rare entity in Jordan, and the majority of intestinal and gastric lymphomas were diffuse large cell lymphomas. Histopathologic evidence of mucosa-associated lymphoid tissue origin was seen in at least 18% of the gastric cases. B-cell lymphomas were by far the most common type seen, and T-cell lymphomas were rare.

Adolescent↗

Drug-induced admissions to medical wards at Jordan University Hospital.

The objective of this study was to determine the prevalence of drug-induced disease necessitating hospital admission to Jordan University Hospital. This study also attempted to identify the most commonly involved drugs as well as the vulnerable groups of patients and the potential causes which favor the problem. All admissions to Internal Medicine Department were screened for drug-induced causality by detailed drug history and appropriate examination. The prevalence rate of drug-induced admissions was 3.6%, 52% of them were females. Many of the cases were of severe nature. Most of the cases were due to predictable effects of the drugs used, which were mainly chemotherapeutic agents. The bone marrow was the most affected body organ. Results are in agreement with reports published elsewhere and can be explained by the fact that Jordan University Hospital is the main teaching hospital in Jordan, has an intermediate location and is a referral hospital for oncology-hematology service.

Adult↗

Construction of the Jordan basis for the Baker map.

The Jordan canonical form basis states for an invertible chaotic map, the Baker map, are constructed. A straightforwardly obtained recursion formula is presented for construction of the Jordan states and of the spectral decomposition of the Frobenius-Perron evolution operator. Comparison of this method with earlier, subdynamics techniques demonstrates that it is much more direct and simpler. The physical significance of the Jordan states is approached from the point of view of an entropy evolution equation. The method is also applied to the Bernoulli map, yielding its eigenstates more straightforwardly than done previously. (c) 1997 American Institute of Physics.

Journal Article↗

Noncommutative jordan algebras with commutators satisfying an alternativity condition.

The theorems of this paper show that the main results in the structure and representation theory of Jordan algebras and of alternative algebras are valid for a larger class of algebras defined by simple identities which obviously hold in the Jordan and alternative cass. A new unification of the Jordan and associative theories is also achieved.

Journal Article↗

Leishmania species and zymodemes isolated from endemic areas of cutaneous leishmaniasis in Jordan.

BACKGROUND: Cutaneous leishmaniasis (CL) is endemic in the Middle Eastern countries. New cases are emerging in areas previously free of the disease. In Jordan, the diagnosis of cases during the 1960s and 1970s was mainly reported in military hospitals in Amman. Endemicity of the disease was ascertained after reporting a total of 524 cases during 1973-1978. RESULTS: Leishmania major and Leishmania tropica were isolated from seventy-six autochthonous and imported cases of CL, during eight-year period. The highest infection rates recorded were in the central part of Jordan (60.5%), in males (72.4%) and in the age group 21-30 years (30.5%). Lesions were on the exposed sites of the body, mainly on the face (40%). Both Leishmania spp. were isolated from all parts of the country, although L. major was the predominant species (75% of cases) in all areas except in the north part of Jordan. Isoenzyme characterization of the isolates identified four previously undescribed zymodemes (Z). Four Leishmania major zymodemes were found, one of which was a new zymodeme (ZMON-103 variant in GLUD220); L. major ZMON-103 was the most common zymodeme. Four Leishmania tropica zymodemes were identified, of which three were previously unreported. Of these, ZMON-54 var PGD96-97 was isolated from autochthonous cases, whereas ZMON-59 var MDH100 and ZMON-75 var FH110 were obtained from both autochthonous and imported cases, or from an imported CL case, respectively. CONCLUSION: The findings of this study indicate the emergence of the CL disease in new areas. New foci are reported, where the sporadic nature of the cases indicates recent spread of the disease to these areas and the urge for the implementation of control measures.

Journal Article↗

Knowledge, attitude and practice of breastfeeding in the north of Jordan: a cross-sectional study.

BACKGROUND: In Jordan, as in neighboring countries in the Middle East, higher education and higher employment rates in recent years among women have had an impact on traditionally based infant feeding. The objective of this study was to evaluate practice, knowledge and attitude to breastfeeding and to assess factors associated with breastfeeding among women in the north of Jordan. METHODS: A cross sectional study was carried out between 15 July 2003 and 15 August 2003. A total of 344 women with children aged between 6 months and 3 years from five different villages in the north of Jordan were randomly selected and interviewed. Information regarding participants' demographics, infant feeding in first six months of life, knowledge and attitude towards breastfeeding was collected. RESULTS: Full breastfeeding was reported by 58.3%, mixed feeding was reported by 30.3% and infant formula feeding was reported by 11.4%. Almost one third of the full breastfeeding group did so for 6-12 months, and almost two thirds did continue breastfeeding for more than one year. Employed women were more likely not to practice full breastfeeding compared to unemployed women (odds ratio 3.34, 95% CI 1.60, .98), and women who had cesarian delivery were more likely not to practice full breastfeeding compared to those who had vaginal delivery (odds ratio 2.36, 95% CI 1.17, 4.78). Jordanian women had a positive attitude but work place and short maternity leaves had a negative impact on breastfeeding. CONCLUSION: This study showed that a high proportion of Jordanian women did breastfeed for more than one year. However, working women and those who deliver by caesarean section were less likely to breastfeed. It is speculated that adopting facilitatory measures at hospitals and work place could increase the rate of full breastfeeding.

Journal Article↗