Evaluation of a school-based peer-led education program for adolescents with asthma in Jordan

University of Technology, Sydney. Faculty of Nursing, Midwifery and Health.Background: Adolescent asthma, despite being prevalent and having the potential to negatively impact quality of life, can be adequately managed using the support of peer-led education initiatives within the school context. Such programs acknowledge the social importance of peers and schools in shaping adolescents' health- related behaviours, utilising the universal influence of peers in a positive way. Aim: The aim of this study was to determine the effect of a peer-led asthma education program (Triple A - Adolescent Asthma Action) on asthma-related quality of life, knowledge of asthma management, and self-efficacy to resist smoking among students with asthma attending high schools in Jordan by three months post intervention. Methods: A cluster-randomised controlled trial was conducted in 4 high schools in Irbid, Jordan, on students with asthma (n = 261) in years 8, 9, and 10. Students in the two intervention schools (n = 132) were involved in TAJ (Triple A in Jordan) over three weeks, whereas students in the two control schools (n = 129) were not involved in any intervention. The trial followed a pilot study that was used to determine whether Triple A was needed and feasible, with adaptations made to adjust for the Jordanian high school context. As the cluster design was used and three baseline covariates were found, a SAS.PROC.MIXED adjusted model was used to account for these issues. Results: The average age of the students with asthma was 15.2 years (SD = 1.23), and the majority were male (56.7%), with almost one third of all the participating students (27.7%) reporting being smokers. Approximately 70% had a professional asthma diagnosis, and the remainder reported recent wheezing in the last 12 months, but had not been diagnosed with asthma by a health care professional. In fact, the proportion of students with asthma in the whole sample proved larger than expected, as asthma symptoms were prevalent (17.15%). The program was well-received by students and school staff and modifications were minimal. The TAJ program resulted in significant improvement in all outcomes measured in students with asthma. Compared to the control group, students with asthma in the intervention schools had statistically and clinically significant improvements in quality of life (mean difference = 1.35, 95% Cl = 1.04 - 1.76), better asthma-related knowledge (mean difference = 1.62, 95% Cl = 1.15 - 2.19), and higher self-efficacy to resist smoking (mean difference = 4.63, 95% Cl = 2.93 - 6.35) at three months follow-up. In particular, the TAJ group had most improvement in quality of life in the symptom sub-domain scores (change in score = 0.97, p < 0.02) in comparison to the activities and the emotions domains. Conclusion: The school-based peer-led education program (TAJ) has been shown to be successful in promoting the health of adolescents with asthma in Jordan. Triple A proved adaptable and effective in another culture and context and may have potential for other health-related issues for adolescents. It is crucial that health promotion programs like TAJ are implemented for adolescents in Jordan

The Degree of Practising Participatory Leadership by School Principals from the Teachers Point of View in Giza Governorate Abstract

The study aims to identify the degree of practising participatory leadership by school principals from the teachers point of view in Giza Governorate. The study was carried out in (2021/2022). To achieve the objective of the study, the descriptive analytical approach was employed. Out of a total population of 1434 female and male teachers, 340 participants responded to a questionnaire which was also recruited to collect data. The study reveals that the school principals practice of participatory leadership from the teachers point of view in the Giza district of was high. There were statistically significant differences (α) in the sex variable in favor of males. It also finds out that there were differences in the qualification variable in favor of the bachelors degree. Furthermore, differences in the experience variable in favor of teachers, whose experiences were less than 5 years, were noticed. The study recommends adopting the bases of participatory leadership as a means of evaluating and promoting school principals and delegating a part of their powers to their assistants. Moreover, participatory leadership and qualified principals, who are able to lead their schools, could be achieved by holding workshops and courses on participatory leadership. The current study concludes with the need for further studies on participatory leadership

Cigarette smoking in adolescents with asthma in Jordan: Impact of peer-led education in high schools

Background: Peer-led smoking prevention programs focus on teaching adolescentsespecially those with asthma- who are affected most by cigarettes, refusal skills to lower their intention to smoke. The purpose of this study was to determine the impact of a peer-led asthma education program on students who were smokers in terms of self-efficacy to resist smoking, asthma knowledge and asthma-related quality of life

Attitudes of Non-Asthmatic Children Towards Their Asthmatic Peers: Influence of interactions with asthmatic relatives and peers

Objectives: This study aimed to examine non-asthmatic children’s acceptance of and attitudes towards their asthmatic peers in Jordan. Methods: This descriptive cross-sectional study was conducted between September 2015 and January 2016 among 1,812 non-asthmatic children aged 9–13 years old at 10 schools in Zarqa, Jordan. Arabic versions of the Peers Attitude Towards Children with Asthma scale and the Asthma Knowledge Test for Children were used to assess attitudes towards children with asthma and asthma-related knowledge, respectively. Results: A total of 1,586 children participated in the study (response rate: 87.5%). Of these, 158 (10%) and 399 (25.2%) children reported a family history of asthma or knew at least one person with asthma, respectively. Although 50.3% stated that they would sit next to such children in the classroom, only 34.9% reported that they would be friends with an asthmatic child. However, 73.1% of the non-asthmatic children believed that asthmatic children were not pretending to be ill and 61.4% believed that such children were not ill due to their own carelessness. Female non-asthmatic children (P <0.001), those with a family history of asthma (P = 0.004) and those who knew other individuals with asthma (P <0.001) had significantly more positive attitudes towards and acceptance of their asthmatic peers. In addition, age was significantly related to attitude scores (P <0.001). However, there was no correlation between asthma-related knowledge and the children’s attitudes towards peers with asthma (P = 0.611). Conclusion: Previous interactions with asthmatic family members or peers were found to significantly influence non-asthmatic children’s attitudes towards their asthmatic peers. Keywords: Asthma; Children; Attitudes; Knowledge; Jordan

Perceived Patient Safety Culture among Healthcare Providers in Southern Jordanian Hospitals during COVID-19 Pandemic

Background:&nbsp;A good and continuous assessment of the safety culture in the area of providing services in the healthcare sector will provide an initial step towards providing safe conditions for patient care. Aims:&nbsp;This study aimed to evaluate the perception of patient safety culture among healthcare providers in southern Jordanian hospitals during the COVID-19 pandemic. Method:&nbsp;A cross-sectional study was conducted among healthcare providers (physicians, nurses, and their administrators). Between July and November 2021, data was gathered by an Arabic version of the Hospital Survey of Patient Safety Culture Questionnaire (HSPSC) from 531 healthcare providers using the convenience sample approach. In four southern Jordanian hospitals.&nbsp; Results:&nbsp;This study found that there were some areas of strength such as: organizational learning/continuous improvement, communication openness, communication about errors, supervisor, manager, or clinical support for patient safety, and hospital management support for patient safety. The reporting-related composites (response to error and reporting patient safety events), staffing, teamwork across hospital units, and information exchange were areas for improvement. Conclusion:&nbsp;There was a need for advancement in the practices of patient safety culture in southern Jordanian hospitals. Reporting-related composites, staffing, handoffs, and information exchange are areas of patient safety that need quick refinement

Knowledge, Misconceptions and Attitudes towards Labor Regional Analgesia in a University Hospital: A Cross-Sectional Study

Background: Pain relief in labor is considered an important concern in the management of pregnant females in childbirth. The aim of this study is to assess the knowledge and attitudes of Jordanian females towards various regional analgesic techniques. Methods: We conducted a cross-sectional survey on 652 Jordanian women with a mean age of 32.9 (±8.17). Data collection took place at the gynecological and obstetrics clinics between December, 2017 and September, 2018. Results: Subjects with higher educational levels tend to have better knowledge about regional analgesia (p-value = 0.003), are less likely to ask for general anesthesia (GA) (p < 0.001), and have more previous regional analgesia 47.9% (p < 0.001). Moreover, multiparous women had better knowledge about regional analgesia and higher tendency to ask for it as an efficacious analgesic method during delivery (p < 0.05). Conclusions: In conclusion, even though higher educational levels and multiparty were significantly associated with better knowledge and acceptance rate of regional analgesia, sources of information about regional analgesia plays an important role, emphasizing on the significant role of anesthesiologists and obstetricians in increasing the awareness levels in our society

Individual-level determinants of waterpipe smoking demand in four Eastern-Mediterranean countries

© 2018 The Author(s) 2018. Published by Oxford University Press. All rights reserved. The prevalence of waterpipe tobacco smoking in the Eastern Mediterranean Region is at alarmingly high levels, especially among young people. The objective of this research was to evaluate the preferences of young adult waterpipe smokers with respect to potential individual-level determinants of waterpipe smoking using discrete choice experiment methodology. Participants were young adult university students (18-29 years) who were ever waterpipe smokers, recruited from universities across four Eastern Mediterranean countries: Jordan, Oman, Palestine and the United Arab Emirates. The Internet-based discrete choice experiment, with 6 × 3 × 2 block design, evaluated preferences for choices of waterpipe smoking sessions, presented on hypothetical waterpipe café menus. Participants evaluated nine choice sets, each with five fruit-flavored options, a tobacco flavored option (non-flavored), and an opt-out option. Choices also varied based on nicotine content (0.0% vs. 0.05% vs. 0.5%) and price (low vs. high). Participants were randomized to receive menus with either a pictorial + text health-warning message or no message (between-subjects attribute). Multinomial logit regression models evaluated the influence of these attributes on waterpipe smoking choices. Across all four samples (n = 1859), participants preferred fruit-flavored varieties to tobacco flavor, lower nicotine content and lower prices. Exposure to the health warning did not significantly predict likelihood to opt-out. Flavor accounted for 81.4% of waterpipe smoking decisions. Limiting the use of fruit flavors in waterpipe tobacco, in addition to accurate nicotine content labeling and higher pricing may be effective at curbing the demand for waterpipe smoking among young adults

Asthma education for school staff.

BACKGROUND: Teachers and school staff should be competent in managing asthma in schools. Demonstrated low levels of asthma knowledge mean that staff may not know how best to protect a child with asthma in their care, or may fail to take appropriate action in the event of a serious attack. Education about asthma could help to improve this knowledge and lead to better asthma outcomes for children. OBJECTIVES: To assess the effectiveness and safety of asthma education programmes for school staff, and to identify content and attributes underpinning them. SEARCH METHODS: We conducted the most recent searches on 29 November 2016. SELECTION CRITERIA: We included randomised controlled trials comparing an intervention to educate school staff about asthma versus a control group. We included studies reported as full text, those published as abstract only and unpublished data. DATA COLLECTION AND ANALYSIS: At least two review authors screened the searches, extracted outcome data and intervention characteristics from included studies and assessed risk of bias. Primary outcomes for the quantitative synthesis were emergency department (ED) or hospital visits, mortality and asthma control; we graded the main results and presented evidence in a 'Summary of findings' table. We planned a qualitative synthesis of intervention characteristics, but study authors were unable to provide the necessary information.We analysed dichotomous data as odds ratios, and continuous data as mean differences or standardised mean differences, all with a random-effects model. We assessed clinical, methodological and statistical heterogeneity when performing meta-analyses, and we narratively described skewed data. MAIN RESULTS: Five cluster-RCTs of 111 schools met the review eligibility criteria. Investigators measured outcomes in participating staff and often in children or parents, most often at between 1 and 12 months.All interventions were educational programmes but duration, content and delivery varied; some involved elements of training for pupils or primary care providers. We noted risk of selection, performance, detection and attrition biases, although to a differing extent across studies and outcomes.Quanitative and qualitative analyses were limited. Only one study reported visits to the ED or hospital and provided data that were too skewed for analysis. No studies reported any deaths or adverse events. Studies did not report asthma control consistently, but results showed no difference between groups on the paediatric asthma quality of life questionnaire (mean difference (MD) 0.14, 95% confidence interval (CI) -0.03 to 0.31; 1005 participants; we downgraded the quality of evidence to low for risk of bias and indirectness). Data for symptom days, night-time awakenings, restricted activities of daily living and school absences were skewed or could not be analysed; some mean scores were better in the trained group, but most differences between groups were small and did not persist to 24 months.Schools that received asthma education were more adherent to asthma policies, and staff were better prepared; more schools that had received staff asthma training had written asthma policies compared with control schools, more intervention schools showed improvement in measures taken to prevent or manage exercise-induced asthma attacks and more staff at intervention schools reported that they felt able to administer salbutamol via a spacer. However, the quality of the evidence was low; results show imbalances at baseline, and confidence in the evidence was limited by risk of bias and imprecision. Staff knowledge was higher in groups that had received asthma education, although results were inconsistent and difficult to interpret owing to differences between scales (low quality).Available information about the interventions was insufficient for review authors to conduct a meaningful qualitative synthesis of the content that led to a successful intervention, or of the resources required to replicate results accurately. AUTHORS' CONCLUSIONS: Asthma education for school staff increases asthma knowledge and preparedness, but studies vary and all available evidence is of low quality. Studies have not yet captured whether this improvement in knowledge has led to appreciable benefits over the short term or the longer term for the safety and health of children with asthma in school. Randomised evidence does not contribute to our knowledge of content or attributes of interventions that lead to the best outcomes, or of resources required for successful implementation.Complete reporting of the content and resources of educational interventions is essential for assessment of their effectiveness and feasibility for implementation. This applies to both randomised and non-randomised studies, although the latter may be better placed to observe important clinical outcomes such as exacerbations and mortality in the longer term

Health in times of uncertainty in the eastern Mediterranean region, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Background: The eastern Mediterranean region is comprised of 22 countries: Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, the United Arab Emirates, and Yemen. Since our Global Burden of Disease Study 2010 (GBD 2010), the region has faced unrest as a result of revolutions, wars, and the so-called Arab uprisings. The objective of this study was to present the burden of diseases, injuries, and risk factors in the eastern Mediterranean region as of 2013. Methods: GBD 2013 includes an annual assessment covering 188 countries from 1990 to 2013. The study covers 306 diseases and injuries, 1233 sequelae, and 79 risk factors. Our GBD 2013 analyses included the addition of new data through updated systematic reviews and through the contribution of unpublished data sources from collaborators, an updated version of modelling software, and several improvements in our methods. In this systematic analysis, we use data from GBD 2013 to analyse the burden of disease and injuries in the eastern Mediterranean region specifically. Findings: The leading cause of death in the region in 2013 was ischaemic heart disease (90·3 deaths per 100 000 people), which increased by 17·2% since 1990. However, diarrhoeal diseases were the leading cause of death in Somalia (186·7 deaths per 100 000 people) in 2013, which decreased by 26·9% since 1990. The leading cause of disability-adjusted life-years (DALYs) was ischaemic heart disease for males and lower respiratory infection for females. High blood pressure was the leading risk factor for DALYs in 2013, with an increase of 83·3% since 1990. Risk factors for DALYs varied by country. In low-income countries, childhood wasting was the leading cause of DALYs in Afghanistan, Somalia, and Yemen, whereas unsafe sex was the leading cause in Djibouti. Non-communicable risk factors were the leading cause of DALYs in high-income and middle-income countries in the region. DALY risk factors varied by age, with child and maternal malnutrition affecting the younger age groups (aged 28 days to 4 years), whereas high bodyweight and systolic blood pressure affected older people (aged 60–80 years). The proportion of DALYs attributed to high body-mass index increased from 3·7% to 7·5% between 1990 and 2013. Burden of mental health problems and drug use increased. Most increases in DALYs, especially from non-communicable diseases, were due to population growth. The crises in Egypt, Yemen, Libya, and Syria have resulted in a reduction in life expectancy; life expectancy in Syria would have been 5 years higher than that recorded for females and 6 years higher for males had the crisis not occurred. Interpretation: Our study shows that the eastern Mediterranean region is going through a crucial health phase. The Arab uprisings and the wars that followed, coupled with ageing and population growth, will have a major impact on the region's health and resources. The region has historically seen improvements in life expectancy and other health indicators, even under stress. However, the current situation will cause deteriorating health conditions for many countries and for many years and will have an impact on the region and the rest of the world. Based on our findings, we call for increased investment in health in the region in addition to reducing the conflicts