Colorectal cancer screening barriers and facilitators among Jordanians: A cross-sectional study

The factors affecting the adherence of Jordanians to colorectal cancer (CRC) screening remain underexplored. We examined the inhibitory and facilitating factors that influence the uptake of CRC screening among Jordanians. We conducted questionnaire interviews between April 2020 and June 2021 with 861 Jordanians aged 50-75. We analyzed the differences between proportions using the chi-square test. Binary logistic regression was conducted to determine factors associated with awareness of CRC and its screening. Of all participants, 41.7 % were aware of the necessity of screening for CRC, and 27.2 % were aware of at least one of the tests for CRC screening. However, only 17.2 % of participants underwent screening. In the multivariate analysis, participants with higher income (p-value \u3c 0.001, odds ratio[OR] = 1.9, 95 % confidence interval [CI]: 1.4-2.7), higher level of education (p-value \u3c 0.001, OR = 2.6, 95 % CI: 1.8-3.7), family history of colon cancer (p-value \u3c 0.001, OR = 2.8, 95 % CI = 1.7-4.5), and those who had been screened for other cancers (p-value = 0.003, OR = 1.7, 95 % CI: 1.2-2.5) were more aware of the necessity of screening. Concerning barriers to screening, \u27feeling well,\u27 lack of physician endorsement, and difficult access to health care were the most commonly reported inhibitory factors (53.9 %, 52.3 %, and 31.9 %, respectively). The most commonly stated incentivizing factor was physician endorsement (82.3 %). Screening rates for CRC in eligible Jordanians remain low, albeit more than one-third of participants are aware of the necessity of screening. Enhanced awareness of barriers and incentivizing factors should help to prioritize national strategies to improve screening rates

Medical education across three colleges of medicine: perspectives of medical students

AimThis study aimed to explore and evaluate various components of the medical education process (lectures, labs, small-group discussions, clinical rotations, and undergraduate research) in three colleges of medicine in Jordan. MethodsThis cross-sectional questionnaire-based study included 849 undergraduate students from three main medical colleges in Jordan. Statically valid responses were considered for 684 students. The participants were from Jordan University of Science and Technology, Yarmouk University, and the University of Jordan. ResultsThe distribution of students according to their admission status was 276 (40%) regular, 266 (38.9%) parallel, and 142 (20.8%) international programs. Personal interest and self-initiation were the major motives for studying medicine in 66.1%. Regarding the frequency of attending classes, University of Jordan students reported the highest rate of regular classes' attendance (93%). The study also reported that lecture notes and textbooks were the main sources of learning for medical students. The study also reported superior academic performance of students in the regular program compared to students in the parallel and international programs. Participants of the study criticized the medical curricula in the three colleges mentioned above because of the lack of active research programs. Most of the students (40%–56%) also complained that the lectures within the modules were not well-integrated, and they felt that the academic environment was moderate (48–59%). In addition, most students in the clinical phase complained of overcrowding in hospital wards during clinical rotation. ConclusionsBased on students' feedback, multiple aspects of the medical education process require substantial reform to meet the expectations of medical students in Jordan.This study was supported by the Deanship of Research at JUST (2015/513). Dr. Ayman Mustafa is currently at leave from JUST. Open access funding provided by the Qatar National Library

Critical care nurses' experiences during the Illness of family members : a qualitative study

Introduction: A loved one's hospitalization in a critical care unit is a traumatic experience for families. However, because of their status and professional competence, a family member who is also a critical care nurse has additional obstacles and often long-term consequences. Objectives: To describe the experiences of critical care nurse-family members when a loved one is admitted to a critical care unit at the Hotel-Dieu de France hospital. Methods: A qualitative path based on van Manen's hermeneutic phenomenology combining both descriptive and interpretive models were adopted. Results: The lived experience of critical care nurses in providing care for their family members admitted into the same critical care were summarized in five themes. Nurses were torn between roles, consisting of confounding roles, their registered nurse status, and watchfulness. The lived experience of critical care nurses in providing care for their family members admitted into the same critical care was summarized into specialized knowledge that included a double-edged sword of seeking information and difficulty delivering the information. Critical nurses compete for expectations, including those placed on self and family members, resulting in emotional and personal sacrifice while gaining insight into the experiences. Conclusions: Critical care nurse-family members have a unique experience compared to the rest of the family, necessitating specialized care and attention. Increased awareness among healthcare providers could be a start in the right direction

Prevalence of nicotine dependence among university students in Jordan: a cross-sectional study

Tobacco epidemic is one of the biggest public health threats the world has ever encountered. The objective of this study was to identify the prevalence of nicotine dependence among university students in Jordan and assess factors associated with this dependence.  A cross-sectional study using simple random sampling was conducted among university students from 3 public and 3 private universities selected for their convenience from central, middle, and east Jordan via administering a questionnaire between October 2016 and January 2017. The total number of participants was 892.  The overall nicotine dependence was 51.2%. Correlates to nicotine dependence were studying at an undergraduate level (OR=3.6; 95% CI: 1.4-8.1); studying humanities (OR=1.73; 95% CI: 1.2-2.1); existing of a smoking family member (OR=1.63; 95% CI: 1.5-1.9); starting smoking before age of 15 years (OR=1.60; 95% CI: 1.2-2.1); water pipe smoking (OR=1.48; 95% CI: 1.1-2.0); and studying at governmental universities (OR=1.36; 95% CI: 1.0-1.8).  Several socio-demographic characteristics had an impact on nicotine dependence. Future research is necessary to further improve our understanding of motives for smoking and dependence.&nbsp

Coping Strategies of Jordanian Adolescents With Cancer: An Interpretive Phenomenological Analysis Study

Interpretive phenomenological analysis methodology was used to explore coping strategies used by hospitalized Jordanian adolescents with cancer. In-depth face-to-face interviews were conducted with 10 Jordanian adolescents, aged 13 to18 years, who were receiving chemotherapy for cancer. During treatment, participants were confronted with physical, psychosocial, and emotional distresses resulting from the disease process, the treatment, and its associated side-effects. To cope with the impact of their illness, participants utilized 4 coping strategies: "Strengthening spiritual convictions," "Being optimistic and rebuilding hope," "Enhancing appearance," and "Finding self again." The findings of this study can assist health team members to promote positive psychological care to Arab Muslim adolescents with cancer in a supportive and therapeutic treatment environment

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Factors associated with high turnover of Jordanian physicians in rural areas: a sequential exploratory mixed method study

Background: The high turnover of physicians in rural areas of Jordan, a low-middle income country in the Middle East, has adversely affected the provision of primary health care. This study was undertaken in an effort to understand the reasons for this high turnover and to inform health policy makers to formulate more effective strategies to counter this problem which also affects many developing and developed countries around the world. Methods: A sequential exploratory mixed method design was chosen for the study with the data collection in two phases. In the first phase, qualitative data was gathered using focus group interviews. Four focus groups were considered and each group consisted of five participants. Participants in the focus groups were purposefully sampled and represented currently posted rural physicians, previously posted rural physicians, health directors, and consumers of health services from the general rural community. In the second quantitative phase, a cross-section of currently posted Jordanian rural physicians was surveyed using a 98-item questionnaire whose design was informed by findings from the first qualitative phase. A total of 307 completed questionnaires were elicited in this survey. Qualitative data were analysed with the help of the QSR-NVivo 8 software using thematic analysis, while quantitative data were analysed with SPSS version 19, using both descriptive and analytical statistical procedures including frequency distributions, Chi-Square Tests and logistic regression. Results: Due to the cross-sectional observational nature of the study design, it was not possible to prospectively measure turnover rate among currently working physicians, rather intention-to-leave was used as an indicator of turnover. By this measure, the overall intention to leave rural practice among the currently employed rural physicians in Jordan was 29.3%. A large number of personal, organizational, work related and socio-cultural factors were identified and found to be associated with turnover of rural physicians. Some of these factors V have been reported in the previous literature; however, others were specific to the Jordanian context. Factors revealed during focus group discussions included - financial incentives, professional development, workload issues, rural background of medical practitioners and rural exposure during training, transportation issues, demographic characteristics of participants, management related factors, social isolation of rural physicians, lack of treatment facilities, poor general services, lack of resources, lack of opportunities for spouses’ career development and socio-cultural characteristics of the Jordanian community. A framework of the association between the various factors associated with turnover of rural physicians was established from the qualitative phase. Findings from the quantitative phase complemented the factors documented in the qualitative phase, and in addition identified physician’s age, method of appointment to work sites, daily travelling time, workload, satisfaction about referral policy, and social isolation as significant factors affecting turnover. Conclusion: Physicians in rural Jordan are dissatisfied with a large range of organizational, social and personal factors. These factors could lead to a high rate of physicians’ turnover and therefore impede the quality of health services offered to rural communities. A number of recommendations were formulated to inform decision makers and health policy planners to address the issue of high physician turnover in rural Jordan. In addition, the study generated directions for future research, especially through cohort or prospective studies, to track progress in the area and to evaluate the impact of both organizational and personal factors on physician turnover

First aid knowledge among University students in Jordan

Background: This study has aimed to evaluate the level of knowledge about the first aid process among the university students in Jordan. Methods: The study population consisted of students of the 14 scientific and unscientific faculties at Yarmouk University, Jordan. Data were obtained via questionnaires from 883 students. Results: The majority of participants were females (65.9%) with mean age (standard deviation) of 19.9 (2.6) years. Only 29.2% of students had previous first aid experience. When asked, only 11% of students knew the normal respiration rate of an adult in 1 min. Results revealed that female students, having previous first aid experience, and being a student of the health sciences and scientific colleges were the only factors had significant statistical associations with better level of first aid knowledge. Conclusions: The students′ knowledge about first aid is not at an adequate level. It would be advisable that first aid course be handled as a separate and practical course at secondary school level