Advancing Tobacco Dependence Treatment Services in the Eastern Mediterranean Region : International collaboration for training and capacity-building

Tobacco use negatively affects health and is a major risk factor for non-communicable diseases (NCDs). Today, tobacco use ranks third among risk factors in North Africa and the Middle East in terms of disease burden. Despite the established need for these services, tobacco dependence treatment (TDT) services are still inadequate in the Eastern Mediterranean region (EMR). Among the main challenges hindering their expansion is the current lack of training opportunities. The provision of training and capacity-building—a key enabler of TDT—offers an excellent catalyst to launch TDT services in the region. This review discusses the need for TDT training in the EMR and describes a model for providing regional evidence-based training in line with international standards. The King Hussein Cancer Center in Amman, Jordan, is the regional host for Global Bridges, a worldwide TDT initiative. Using this model, they have trained 1,500 professionals and advocates from the EMR over the past three years

Perceptions of young Jordanian adults to proposed anti-tobacco pictorial warning labels

<p>Abstract</p> <p>Background</p> <p>In commitment to the Framework Convention on Tobacco Control (FCTC), four new pictorial warnings are now being proposed for display on cigarette packages sold in Jordan. The aim of this study was to gauge the immediate perceptions of young Jordanian adults towards these new pictorials and compare these perceptions to those of the pictorial currently being used in the country.</p> <p>Methods</p> <p>A cross-sectional survey was conducted on a convenience sample of youth aged 17-26. The interviewer-administered survey gauged participants' perceptions of salience, fear elicitation, and gained information as well as participants' motivation to remain non-smokers or quit smoking after viewing each of the four proposed new pictorials as well as the current pictorial used in Jordan. Perceptions regarding each new pictorial were compared to the current pictorial.</p> <p>Results</p> <p>A total of 450 surveys were included in the analysis. The sample (mean age 20.9) was 51.6% female and 31.3% cigarette (regular or occasional) smokers. In smokers, only one proposed pictorial had significantly more smokers perceiving it as salient or adding to information when compared to the current pictorial. More smokers reported fear when observing the proposed pictorials compared with current pictorial, but overall proportions reporting fear were generally less than 50%. Furthermore, all new pictorials motivated significantly more smokers to consider quitting compared with the current pictorial; however, the overall proportion of smokers reporting motivation was < 25%. Among nonsmokers, significantly more respondents perceived the new pictorials as salient and fear-eliciting compared to the old pictorial, but there were no major differences in information added. Motivation to remain non-smokers was comparable between the old and new pictorials.</p> <p>Conclusion</p> <p>Given the variability of response across both smokers and nonsmokers, and across the three elements of perception (salience, added information, fear) for each pictorial, further testing of the pictorials in a more diverse sample of Jordanian young adults prior to launch is recommended.</p

The Emerging Global Tobacco Treatment Workforce: Characteristics of Tobacco Treatment Specialists Trained in Council-Accredited Training Programs from 2017 to 2019

Tobacco use is projected to kill 1 billion people in the 21st century. Tobacco Use Disorder (TUD) is one of the most common substance use disorders in the world. Evidence-based treatment of TUD is effective, but treatment accessibility remains very low. A dearth of specially trained clinicians is a significant barrier to treatment accessibility, even within systems of care that implement brief intervention models. The treatment of TUD is becoming more complex and tailoring treatment to address new and traditional tobacco products is needed. The Council for Tobacco Treatment Training Programs (Council) is the accrediting body for Tobacco Treatment Specialist (TTS) training programs. Between 2016 and 2019, n = 7761 trainees completed Council-accredited TTS training programs. Trainees were primarily from North America (92.6%) and the Eastern Mediterranean (6.1%) and were trained via in-person group workshops in medical and academic settings. From 2016 to 2019, the number of Council-accredited training programs increased from 14 to 22 and annual number of trainees increased by 28.5%. Trainees have diverse professional backgrounds and work in diverse settings but were primarily White (69.1%) and female (78.7%) located in North America. Nearly two-thirds intended to implement tobacco treatment services in their setting; two-thirds had been providing tobacco treatment for 1 year or less; and 20% were sent to training by their employers. These findings suggest that the training programs are contributing to the development of a new workforce of TTSs as well as the development of new programmatic tobacco treatment services in diverse settings. Developing strategies to support attendance from demographically and geographically diverse professionals might increase the proportion of trainees from marginalized groups and regions of the world with significant tobacco-related inequities

Remdesivir and three other drugs for hospitalised patients with COVID-19: final results of the WHO Solidarity randomised trial and updated meta-analyses.

BACKGROUND World Health Organization expert groups recommended mortality trials of four repurposed antiviral drugs - remdesivir, hydroxychloroquine, lopinavir, and interferon beta-1a - in patients hospitalized with coronavirus disease 2019 (Covid-19). METHODS We randomly assigned inpatients with Covid-19 equally between one of the trial drug regimens that was locally available and open control (up to five options, four active and the local standard of care). The intention-to-treat primary analyses examined in-hospital mortality in the four pairwise comparisons of each trial drug and its control (drug available but patient assigned to the same care without that drug). Rate ratios for death were calculated with stratification according to age and status regarding mechanical ventilation at trial entry. RESULTS At 405 hospitals in 30 countries, 11,330 adults underwent randomization; 2750 were assigned to receive remdesivir, 954 to hydroxychloroquine, 1411 to lopinavir (without interferon), 2063 to interferon (including 651 to interferon plus lopinavir), and 4088 to no trial drug. Adherence was 94 to 96% midway through treatment, with 2 to 6% crossover. In total, 1253 deaths were reported (median day of death, day 8; interquartile range, 4 to 14). The Kaplan-Meier 28-day mortality was 11.8% (39.0% if the patient was already receiving ventilation at randomization and 9.5% otherwise). Death occurred in 301 of 2743 patients receiving remdesivir and in 303 of 2708 receiving its control (rate ratio, 0.95; 95% confidence interval [CI], 0.81 to 1.11; P = 0.50), in 104 of 947 patients receiving hydroxychloroquine and in 84 of 906 receiving its control (rate ratio, 1.19; 95% CI, 0.89 to 1.59; P = 0.23), in 148 of 1399 patients receiving lopinavir and in 146 of 1372 receiving its control (rate ratio, 1.00; 95% CI, 0.79 to 1.25; P = 0.97), and in 243 of 2050 patients receiving interferon and in 216 of 2050 receiving its control (rate ratio, 1.16; 95% CI, 0.96 to 1.39; P = 0.11). No drug definitely reduced mortality, overall or in any subgroup, or reduced initiation of ventilation or hospitalization duration. CONCLUSIONS These remdesivir, hydroxychloroquine, lopinavir, and interferon regimens had little or no effect on hospitalized patients with Covid-19, as indicated by overall mortality, initiation of ventilation, and duration of hospital stay. (Funded by the World Health Organization; ISRCTN Registry number, ISRCTN83971151; ClinicalTrials.gov number, NCT04315948.)

Pictorial warning labels in Jordan: are we maximizing the benefit for smokers?

Background Pictorial warning labels (PWLs) motivate smokers to quit and support continued abstinence. In Jordan, where 70% of adult males smoke, mass media campaigns are non-existent making PWLs of additional importance in communicating the benefits of quitting and prompting quit attempts. Methods We conducted an evaluation of the PWLs used in Jordan after having them in circulation for 2.5 years. We surveyed a cross-sectional convenience sample of smokers aged 17-26 years (n=309). Respondents were asked about: previous quit attempts, beliefs in the need for PWLs and for more information within PWLs, frequency of noticing PWLs and recall of PWL messages, and considering quitting in response to PWLs. Finally, they were prompted with individual PWLs, and requested to rate each on its ability to evoke fear, add information, and motivate quitting. Results Results indicate that: - 49% (150/309) of the respondents have had a failed quit attempt in the 12 months preceding the survey - 48% (149/309) of the respondents believe there is a need for PWLs, among which 54% (81/149) believe that PWLs should provide more information - 63% (195/309) of the respondents noticed PWLs frequently in the month preceding the survey, among which 86% (168/195) correctly recalled at least one PWL message - 36% (71/195) of those reporting frequent notice of PWLs also report considering quitting in response to PWLs Respondents' rating of the individual PWLs is depicted in Figure 1. [Figure 1] Conclusions In Jordan, smokers seem to believe PWLs are necessary and seem to be affected by them to the extent of considering quitting. Yet, given the rate of failed quit attempts, and in light of the request for more information in PWLs, authorities in Jordan should consider supplementing PWLs with content to support self-efficacy to quit, such as including information on the available cessation services and behavioral tips for unaided quitting

Scaling up the availability of tobacco dependence treatment training: leveraging the experience of King Hussein Cancer Center to create new training hubs

Background and challenges to implementation Despite their proven value, tobacco dependence treatment (TDT) services are short in the Eastern Mediterranean Region (EMR) partly due to the lack of expertise among healthcare providers (HCPs). Since training is a proven strategy to avail TDT, King Hussein Cancer Center (KHCC) trained 2,000 HCPs in EMR (between 2011 and 2016). However, centralization meant limited training capacity, calling for scaling up. Intervention or response KHCC collaborated with institutions in Oman, Egypt, Tunisia, and Morocco to build sustainable evidence-based local training hubs. The collaborating institutions host and manage the hubs. (1) In each country, needs were assessed to inform identification of target audiences, program design, and selection of HCPs to serve as trainers; and relevant system-level barriers and facilitators were scanned. (2) KHCC shared its evidence-based training curriculum with hubs for translation and necessary customization. (3) KHCC held training of trainers (ToT) workshops, observed trainers in action, and provided feedback. The ToT workshops provided an opportunity for the group of trainers to reflect on barriers and plan action for a TDT-supporting environment. Results and lessons learnt 84 HCPs were engaged as trainers (all non-smokers and mostly clinicians). Results from two rounds of semi-annual post-ToT online follow up indicate trainer engagement (Table 1). Respondents report the need for strengthened TDT clinical experience as a barrier to engaging in training, and administrative issues and shortage of medications as barriers to practice. Table 1: Results from long-term follow up of hub trainers (self-reports) &nbsp; Percentage of trainers … &nbsp; … practicing TDT … offering TDT training through workshops … offering on-the-job TDT training … interacting with fellow trainers from their own country … interacting with fellow trainers from other countries Results of first semi-annual follow up (response rate 40%) 80% 36% 42% 41% 6% Results of second semi-annual follow up (response rate 25%) 81% 25% 39% 62% 19% [Table 1] Within the first year of launching, the hubs offered 8 training workshops through their local trainers (almost double KHCC's historical capacity of 4.5 workshops). Hubs also report miscellaneous TDT awareness activities, and TDT advocacy work. Conclusions and key recommendations Our program succeeded in expanding the availability of TDT training and in building a network of trainers/advocates. Yet, hubs need to strengthen their advocacy role to address barriers holding them from achieving full potential, such as those preventing some trainers from engaging in training

Parents Knowledge, attitude and practice of antibiotic use for upper respiratory tract infections in children: a cross-sectional study in Ras Al khaimah, United Arab Emirates

Background: Upper respiratory tract infections are common in children and represent a significant cause of antibiotic abuse. Parents’ knowledge and attitudes often contribute to inappropriate prescription of antibiotics and promoting antibiotics resistance. The study aimed at exploring parental knowledge, attitudes and practices towards antibiotic use in children with URTI along with identifying the reasons behind self-medication and abuse of antibiotics Methods: A cross sectional survey was conducted at pediatric outpatient clinics of Saqr Hospital in the emirate of Ras Al Khaimah,United Arab Emirates A structured interview questionnaire was used to collect data from 239 parents of children aged less than7 years, between February to March 2016 Results: More than half (54.4%) of the respondents had a poor level of knowledge. About (66.1%) were not aware that antibiotics are indicated to treat bacterial infection. However, 67.2 % of the respondents incorrectly identified that antibiotics are used to treat viral infections. Nearly 44.5 % of the respondents were aware of antibiotic resistance in relation to its overuse. With regard to attitude, 68.2% of the respondents believed that they would be satisfied if physicians did not prescribe antibiotics for common cold. Yet, 63% would request it if physicians did not prescribefor frequent URTIs. Nearly 43.5% of respondents gave self-medication to their children mostly because of repeated similar attacks and over the counter acquisition of antibiotics. Most (82.2%) of them declared that, physicians did not provide sufficient information regarding diagnosis and therapy More than half (54.4%) of the respondents had a poor level of knowledge. About (66.1%) were not aware that antibiotics are indicated to treat bacterial infection. However, 67.2 % of the respondents incorrectly identified that antibiotics are used to treat viral infections. Nearly 44.5 % of the respondents were aware of antibiotic resistance in relation to its overuse. With regard to attitude, 68.2% of the respondents believed that they would be satisfied if physicians did not prescribe antibiotics for common cold. Yet, 63% would request it if physicians did not prescribe for frequent URTIs. Nearly 43.5% of respondents gave selfmedicationto their children mostly because of repeated similar attacks and over the counter acquisition of antibiotics. Most (82.2%) of them declared that, physicians did not provide sufficient information regarding diagnosis and therapy Conclusions: Educational programs are needed to raise awareness and correct expectations about judicious use of antibiotic

Informing tobacco control policy in Jordan: assessing the effectiveness of pictorial warning labels on cigarette packs

Abstract Background Pictorial warning labels (PWLs) deter initiation and motivate quitting. Assessing PWLs is important to track effectiveness and wear out. Jordan introduced an updated set of PWLs in 2013. This study assessed the effectiveness of the set after 2.5 years on the market. Methods We administered a survey in a cross-sectional sample of young adults aged 17–26 years. For convenience, respondents were recruited on university campuses. For heterogeneity, respondents were solicited from the different schools in four geographically diverse university campuses. The study compared perceptions of effectiveness surveyed in 2015 to perceptions gauged in 2010 during a pre-launch evaluation exercise. Outcomes of interest were: salience, fear evocation, adding information, and ability to motivate quitting smoking (for smokers) or deterring starting (for non-smokers). Results Results indicate awareness of the set among smokers and non-smokers, and their recall of at least one PWL message. Results also indicate effectiveness of the set: (1) 1/3 smokers who frequently saw them reported PWLs to trigger considering quitting, (2) and among both smokers and non-smokers the set in 2015 sustained ability to motivate quitting and staying smoke-free. However, results uncover erosion of salience, suggesting that the set has reached its end of life. Finally, results reveal variability in performance among PWLs; the one PWL that depicts human suffering significantly outperformed the others, and its ability to motivate was most strongly associated with its ability to evoke fear. Conclusion Based on the early signs of wear-out (i.e. erosion of salience), and understanding the importance of sustaining upstream outcomes (especially fear evocation) to sustain motivation, we recommend retiring this set of PWLs and replacing it with a stronger set in line with proven standards