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Epidemiology of cutaneous leishmaniasis in Jordan: 1983-1992.

BACKGROUND: The extent of the problem of cutaneous leishmaniasis in Jordan during the decade 1983 to 1992 was investigated. METHODS: Data were collected from the dermatology departments and the laboratories of the Royal Medical Services and the Ministry of Health as well as from private dermatologists. Two thousand two hundred and ninety-five cases were verified of whom men represented 80%. The majority (80%) were < 25 years with the highest percentage (31%) occurring in the 16 to 20-year age group. RESULTS: The lowest number of cases was reported in June compared to the maximum in October, and the highest number recorded per year was 463 in 1992. For the decade, the Jordan Valley was the most important locality where 43% of the cases occurred. The incidence rate per 100,000 ranged from 1.89 in 1989 to 14.39 in 1984 and the period prevalence for the decade was 5.36 per 100,000. The time-lag between the appearance of a lesion and the first diagnosis extended from 0 to 23 months with the average being 2 months. The number of lesions per patient ranged from one to 45; 24% were located on the face, 28% on the upper extremity, 36% on the lower extremity, and 12% on other sites. CONCLUSIONS: The factors that contributed to the findings include infected rodent, nonexposed army recruits and farm workers, land reclamatory and relaxation of preventative measures.

Adolescent↗

Bringing the professional challenges for nursing in Jordan to light.

The definition of a profession consists of contributing characteristics. Nursing must achieve these characteristics in order to confirm its professional status. These characteristics include: a standard of education; professional organizations; commitment; autonomy; continuing education; body of knowledge and competencies; social value; and a code of ethics. Nursing in Jordan faces a unique set of challenges to meet these criteria. The purpose of this discussion is to bring the professional challenges of nursing in Jordan to light, to motivate collaborative efforts to remediate them and to discuss the value of evidence-based practice in this process. The key to confirming Jordanian nurses' professional status is for nurses to seek every opportunity to prove themselves, earn respect, take control over their work, support their colleagues and to make informed decisions. In addition, a more active and effective role for the nursing organizations is necessary to change the public's view of nursing. Efforts to reform regulation also should be intensified.

Clinical Competence↗

Prevalence of hemoglobin S and beta-thalassemia in northern Jordan.

OBJECTIVE: The aim of this study was to determine the incidence of HbS and beta-thalassemia in the Northern Jordan. STUDY DESIGN: The investigation targeted 3 areas of Northern Jordan. Blood samples from 2,290 volunteers were evaluated to determine the prevalence of HbS and beta-thalassemia by preparing a hemolysate for cellulose acetate electrophoresis. An additional 568 newborn samples were collected from the umbilical and analyzed for the presence of HbS using electrophoresis. RESULTS: The overall prevalence of HbS and beta-thalassemia was 4.45% and 5.93%, respectively. The incidence of sickle cell trait in the newborn sample was 3.17%. The prevalence of both HbS and beta-thalassemia was higher in the Al-Gor area in comparison to Ajloun and Irbid. CONCLUSION: A better understanding of the demographics of these diseases has the potential to aid in the more efficient utilization of health care resources and improved planning and provision of health care services.

Adult↗

Nursing practice issues in Jordan: student-suggested causes and solutions.

BACKGROUND: The causes of the worldwide shortage of registered nurses are complex and require a multifaceted approach to the solution. It is imperative that issues of the practice environment are addressed because creating quality practice environments is essential to provide high-quality care and to persuade nurses to remain in practice. AIMS: The aims of this paper are to describe an international collaborative relationship, and to identify, describe and suggest solutions to three nursing practice issues relevant to Jordanian nursing. METHOD: Two faculty members, one from Jordan and one from Canada, collaborated via e-mail to develop a fourth-year course on nursing leadership and management, which was then jointly taught by them. A student assignment required students, working in groups, to identify a nursing practice issue in Jordan and suggest contributing causes and solutions. CONCLUSION: The issues identified by the students were: unclear role expectations, burnout and turnover, all of which were viewed as contributing to problematic practice settings. The students suggested possible solutions to the practice environment issues.

Attitude of Health Personnel↗

Willingness of dentists in Jordan to treat HIV-infected patients.

UNLABELLED: Reluctance of dentists to treat human immunodeficiency virus (HIV) positive patients represents a major concern. Many efforts have been extended towards the documentation of the extent of this reluctance and speculation of factors that influence it. OBJECTIVES: Assess the willingness of dentists in Jordan to treat HIV-infected patients. MATERIALS AND METHODS: Two hundred and forty-two general dental practices were surveyed for their willingness to provide treatment of toothache and routine dental care of an HIV-infected individual. RESULTS: Only 15% of the dental practices were willing to provide such care. Willingness to provide treatment did not seem to be influenced by financial factors or the local prevalence of HIV disease. CONCLUSION: Present data suggest that HIV-infected individuals will have difficulty in obtaining dental health care in Jordan.

Attitude of Health Personnel↗

Assessment of periodontal knowledge and periodontal status of an adult population in Jordan.

The aim of this study was to assess periodontal knowledge and periodontal status in 20-60-year-old adult population in northern Jordan. A convenient sample consisting of 722 adults was included in this study. A questionnaire incorporating items related to socio-demographic and periodontal knowledge questions was completed before clinical examination, using the Community Periodontal Index of Treatment Needs (CPITN). The results showed that the proportions of subjects who reported bleeding gums, gums' irritation, rough tooth surface and gum disease decreased steadily with age, there is an evident linear trend with high statistical significant difference among various age groups (P < 0.001). Furthermore, the proportions of subjects who answered correctly the periodontal knowledge questions related to plaque definition and its role in disease aetiology and prevention, decreased with age, with a high significant difference for all knowledge questions (P < 0.001). The prevalence of subjects with healthy periodontium (score 0) decreased with age, being 41.1% among 20-29-year-old group and 11.1% in 50-60-year-old group. Similar trend was seen for bleeding on probing (score 1) whilst calculus deposit (score 2) was the major problem in all age groups over 29 years. The prevalence of periodontal pockets was relatively low, with a range of 4.5-18.6% for shallow pockets (score 3) and 2.9-11.1% for deep pockets in younger and older age groups, respectively. Younger age group had more healthy sextants than older age groups. In addition, sextants with bleeding on probing were highest in 20-29-year-old age group (1.8) compared with that in 50-60-year-old age group (0.60) whilst those with calculus deposits varied slightly among different age groups (1.50-1.65). Sextants affected by shallow or deep pockets increased steadily with age. Such a finding was also noted in excluded sextants, with an increase from 0.15 at 20-29 year-old group to 0.94 at the age of 50-60 years. It is concluded that health knowledge and status related to periodontal disease is still poor in northern Jordan. Therefore, dental health education provision is necessary to improve oral health knowledge and conditions among population in general and among older population in particular.

Adult↗

Dental plaque, caries prevalence and gingival conditions of 14-15-year-old schoolchildren in Jerash District, Jordan.

The aim of this cross-sectional study was to evaluate oral hygiene, gingival condition and dental caries prevalence in 14-15-year-old school children in Jerash District, Northern Jordan. Twenty schools (10 male and 10 female schools) with 1362 children of eighth and ninth grades were randomly selected and incorporated in this study. All participants had dental examinations for oral hygiene, gingival condition and dental caries experience using the Silness and Löe Plaque Index (PI), Löe and Silness Gingival Index (GI), and decayed (D), missing (M) and filled (F) teeth (DMFT) and surface (DMFS) codes respectively. The results showed that males had significant lower plaque but significantly higher gingival scores than females (P < 0.001). About 24% of children were caries-free. The proportions of children with one, two or three decayed teeth were between 10% and 18%. Slight non-significant variations between males and females were observed in regard to DMFT/S and their components (P < 0.05). It is concluded that significant gender variations were noted in PI and GI scores but not in DMFT/S or their components. However, the values of these clinical scores were lower than those results previously reported in northern Jordan.

Adolescent↗

Composite resin restorations: a cross-sectional survey of placement and replacement in Jordan.

AIMS: To record the reasons for first time placement and replacement of composite resin restorations in Jordan, to determine the use of composite resin restorations in common cavity types and to collect data on the age of the replaced composite resin restorations. SUBJECTS AND SETTING: Dentists in Jordan (n = 241). METHOD: Cross- sectional study using postal survey backed up with personal contact. Data were recorded for all restorations placed or replaced over a period of one month. RESULTS: Information was collected on 2,239 restorations from patients aged 12-65 years. Of all restorations, 61.6% were first time placements while 38.4% were replacement of old restorations. The major reason for the first time placement of restorations was primary caries while that for replacement was secondary caries 36.2%, followed by root canal therapy 22.2%, discolouration 14.4%, lost restorations 13.4%, composite fracture 11.3%, pain or sensitivity 2.4%. CONCLUSIONS: The main reason for first time placement of composite restorations is primary caries; the main reason for replacement is secondary caries.

Adolescent↗

Risk indicators of pre-eclampsia in north Jordan: is dental caries involved?

BACKGROUND: Despite a huge body of published research, understanding the basic pathology that leads to pre-eclampsia is still incomplete. This study was conducted among women in north Jordan to determine factors associated with pre-eclampsia and to determine if dental caries was involved. METHODS: A case-control study was carried out among women who delivered at Princess Badea Teaching Hospital, Irbid, North Jordan, between September 1, 2004 and January 1, 2005. 115 women with pre-eclampsia and 230 normotensive controls were included in the study. Information regarding participants' demographics, antenatal history and family history were collected through personal interviews. Several oral parameters were measured for each participant. RESULTS: In multivariate analysis, factors found to be associated with increased odds of pre-eclampsia were age > or =35 years (adjusted OR 2.20; 95% CI 1.08, 4.48), nulliparity (adjusted OR 2.73; 95% CI 1.38, 5.39), emotional stress during pregnancy (adjusted OR 4.22; 95% CI 1.79, 9.90), maternal history of pre-eclampsia (adjusted OR 16.04; 95% CI 5.82, 44.22), family history of cardiovascular diseases (adjusted OR 2.82; 95% CI 1.22, 6.51), family history of pre-eclampsia (adjusted OR 23.26; 95% CI 5.07, 106.78), twin births (adjusted OR 37.79; 95% CI 4.22, 338.51), and Body Mass Index (BMI). In comparison with women with pre-pregnancy BMI <25, adjusted OR were 1.97, 95% CI 1.02, 3.81 for women with BMI from 25 to 29.9, and 3.31, 95% CI 1.36, 8.03 for women with BMI > or =30. Mean decayed teeth surface was found to be associated with increased odds of pre-eclampsia (adjusted OR 1.14, 95% CI 1.03, 1.27). CONCLUSION: This study demonstrated no difference to reported risk indicators of pre-eclampsia in other populations, but adds that dental caries may have an association with increased odds of pre-eclampsia.

Adolescent↗

Genetic variants of factor B in a population of Jordan.

BF phenotyping was performed in a population of Jordan. The observed allele frequencies were as follows: BF*S = 0.5457, BF*F = 0.3744, BF*SO7 = 0.0763, BF*F1 = 0.0075. These values are in agreement with the geographic position and the ethnic composition of Jordan.

Complement Factor B↗

Inherited bleeding syndromes in Jordan.

This paper presents data on the occurrence and pattern of inherited bleeding syndromes (IBS) in Jordan, a hitherto unexplored problem. In 1978, during the first 12 months of a prospective study at a major medical center, 91 patients from 51 families were diagnosed as having IBS. All patients were referred because of moderate-to-severe bleeding diatheses; they included 52 hemophiliacs, 27 patients with von Willebrand's disease, 4 with hemophilia B (IX-deficit), 2 with afibrinogenemia, 1 with prothrombin deficiency, and 4 were thought to have platelet dysfunction. The clinical and laboratory features of the patients observed in Jordan do not seem to be significantly different from those of patients in Western Europe or North America.

Adolescent↗

Alcohol in medicolegal cases seen at Jordan University Hospital.

The magnitude of alcohol-associated incidents in relation to medicolegal cases, including road traffic accidents and acts of violence, has not been evaluated in Jordan. Between 1993 and 1995, 825 such cases received at Jordan University Hospital were screened for the presence of alcohol. Blood alcohol was positive in 9.1% of vehicle passengers, 9.6% of pedestrians, 12.4% of cases involving violence, 13.6% of drivers, 65% of cases brought by police and in 12.5% of other cases. Blood alcohol concentrations (BAC) ranged from 10-350 mg/dL. BAC of more than 50mg/dL was found in 65% and 55% of driver and violence cases respectively, and in 33% to 69% of the other categories. Alcohol may have contributed to some of these incidents. In cases with positive BAC, prior alcohol intake was frequently denied. There was no association between cases with positive BAC and a particular time, date or occasion.

Accidents, Traffic↗

Cultural meanings of childbirth: Muslim women living in Jordan.

This descriptive, ethnographic study focuses on the experience of childbirth for Muslim women living in Jordan. Thirty-two childbearing women were interviewed in the early postpartum weeks. The audiotaped interviews were transcribed and translated. Themes were identified from the rich, narrative data. Motivations for having children, as well as what constitutes the motherhood feeling, were described. Themes also included the importance of relying on God or Allah for support in childbearing and child rearing. A strong sense of the spiritual dimensions of giving birth within women's traditional, religious, and cultural context was identified. Findings from this study provide insight into the meanings of childbirth for Muslim women living in Jordan. These meanings assist nurses in providing culturally competent care.

Adult↗

Perceptions of lung cancer and smoking among college students in Jordan.

A descriptive, cross-sectional design was adopted to identify college students' knowledge and perceptions of lung cancer and smoking. A random sample of 400 students at the Jordan University of Science and Technology in northern Jordan was subjected to the Lung Cancer and Smoking Survey, which is based on the Health Belief Model. The results show that the prevalence of current smoking is 16.5% and that the prevalence of former smoking is 10.0%. Most (75.3%) of the respondents were aware of the prevalence of lung cancer. Almost all (90.3%) were aware of the cancer risk from air pollution, but fewer (57.5%) were concerned about the risk caused by side-stream smoke. Most disagreed that lung cancer could be easily cured. Former smokers were more knowledgeable than current smokers about the health hazards of smoking, and those who never smoked were more knowledgeable than both. Engineering students were more likely to agree with the benefits of quitting smoking than were medical or science students. Addiction and friends were the reasons most frequently given for not quitting smoking.

Adolescent↗

Utilization of family planning services in the Governorate of Zarqa, Jordan.

Quantitative and qualitative methods are used to explore family planning (FP) utilization in four clinics with different models of provision in Zarqa Governorate in Jordan. Constraints to utilization at the service level are identified based on service observations and the perspectives of providers. Service statistics, clinic observations, and focus group discussions were used to compare utilization patterns and to evaluate the strengths and weaknesses of the different models of provision. Findings show that FP provision is still fragmented and "techno-patriarchal" in Jordan. Strengthening coordination mechanisms between the service sectors and addressing men are important strategies to increase FP utilization that are transferable to other countries of the Middle East and the developing world.

Adolescent↗

The seroprevalences of cystic echinococcosis, and the associated risk factors, in rural-agricultural, bedouin and semi-bedouin communities in Jordan.

An ELISA was used to determine the seroprevalence of cystic echinococcosis (CE), caused by Echinococcus granulosus, in representatives of the rural-agricultural, semi-bedouin and bedouin communities of Jordan. The knowledge, attitudes and practices (KAP) pertaining to the transmission of CE in such communities were also investigated. In the ELISA, serum samples from 2388 subjects were tested for IgG antibodies reacting with antigens in crude sheep hydatid fluid (CSHF). The rural-agricultural subjects were significantly more likely to be seropositive (11.4%) than the semi-bedouin (5.0%) or bedouin (3.7%), but male and female subjects were equally likely to be seropositive. Among the rural-agricultural and semi-bedouin subjects, those aged 11-20 years were most likely to be seropositive. Among the bedouin subjects, however, seroprevalence was highest for those aged 31-40 years. When the distribution of 59 seropositive subjects detected within 36 rural-agricultural households was investigated, 12 (33.3%) of the households were each found to have at least two seropositive members. Immunoblotting indicated that 27.1% of the seropositive rural-agricultural subjects showed immunoreactivity to at least one of the CSHF antigen-B components (of 8-12, 16 and 24 kDa). The living conditions, practices and lifestyles of the rural-agricultural, semi-bedouin and bedouin communities favour the spread of CE in Jordan and warrant an effective programme for the control of the disease.

Adolescent↗

Identification of Leishmania strains from Jordan.

The enzymatic profiles of 22 Jordanian Leishmania isolates obtained from humans, Psammomys obesus and Phlebotomus papatasi were determined using starch-gel electrophoresis and a 15-enzyme system. Thirteen of the isolates were typed as L. major and the other nine, all from Mediterranean or sub-Mediterranean regions, as L. tropica. The two zymodemes of L. major encountered, MON-26 and MON-103, differed in terms of purine nucleoside phosphorylase 2. The MON-26 isolates came from the Jordanian plateau whereas those of MON-103 were only collected from the Jordan valley. The four zymodemes of L. tropica observed (MON-7, MON-137, MON-200 and MON-265) were identical for only two of the 15 enzymes studied (i.e. isocitrate dehydrogenase and glucose phosphate isomerase), confirming the high level of enzymatic polymorphism of L. tropica. So far, MON-200 and MON-265 have only been found in Jordan.

Animals↗

Common antimicrobial resistance patterns, biotypes and serotypes found among Pseudomonas aeruginosa isolates from patient's stools and drinking water sources in Jordan.

Pseudomonas aeruginosa was isolated in low rates from stool specimens of outpatients and inpatients (7% versus 12%) but in higher rates from chlorinated and nonchlorinated water sources (15% versus 44%), respectively in Jordan. The same biotype was recognized among 90% of P. aeruginosa isolates from patient's stools and water sources using specific biochemical profiles. Three serogroups belonging to 01, 06 and 011 accounted for the majority of these isolates in water (66%) and stools (78%), respectively. All P. aeruginosa isolates from water were highly susceptible (87%-100%) to piperacillin-tazobactam, amikacin, gentamicin, imipenem, aztreonam, ceftazidime and ciprofloxacin, whereas the isolates from stool were slightly less susceptible (81%-98%) to these antimicrobials. P. aeruginosa isolates from water and stool sources were almost equally highly resistant to tetracycline (86%-89%) and carbenicillin (88%-89%), respectively. One common small plasmid (15.4 kb) was detected in 14/25 (56%) of multidrug-resistant P. aeruginosa isolates from both water and stool. This study demonstrates certain common epidemiological characteristics including antimicrobial resistance pattern, biotypes and serotypes among P. aeruginosa isolates from patient's stools and drinking water sources in Jordan.

Anti-Bacterial Agents↗