Mervat Alsous

Reliability and validity of Arabic translation of Medication Adherence Report Scale (MARS) and Beliefs about Medication Questionnaire (BMQ)-specific for use in children and their parents

Objectives to evaluate the reliability and discriminant validity of Arabic translation of the Medication Adherence Report Scale (MARS) and the Beliefs about Medication Questionnaire-specific (BMQ-specific). Methods Having developed Arabic translations of the study instruments, a cross-sectional study was carried out between March and October 2015 in two multidisciplinary governmental hospitals in Jordan. An expert panel monitored the forward and backward translation of the MARS and BMQ. Standard Arabic was used (with no specific dialect inclusion) to allow greater generalisability across Arabic speaking countries. Once the Arabic translations of the questionnaires were developed they were tested for consistency, validity and reliability on a group of children with chronic diseases and their parents. Results A total of 258 parents and 208 children were included in the study. The median age of participated children and parents was 15 years and 42 years respectively. Principle component analysis of all questionnaires indicated that all had good construct validity as they clearly measured one construct. The questionnaires were deemed reliable based on the results of Cronbach alpha coefficient. Furthermore, reliability of the questionnaires was demonstrated by test-retest intraclass correlation coefficients (ICC) which ranged from good to excellent for all scales (ICC>0.706). The Pearson correlation coefficient ranged from 0.546–0.805 for the entire sample which indicated a significant moderate to strong positive correlation between MARS and BMQ items at time 1 and 2. Reported adherence was greater than 59% using MARS-children and MARS-parents scales, and was correlated with beliefs in necessity and independent of the concerns regarding medications. Conclusion The Arabic translations of both BMQ and MARS for use in children and their parents have good internal consistency and proved to be valid and reliable tools that can be used by researchers in clinical practice to measure adherence and beliefs about medications in Arabic speaking patient populations.

A Cross-Sectional Study On Knowledge and Perceptions of Pharmacovigilance Among Pharmacy Students of Selected Tertiary Institutions In Jordan

Background: Although a large body of evidence exists on the effect of long-term exercise training program on pulmonary function, much less attention has been dedicated to investigating the acute effect of short-term exercise program on improving the ventilatory function. Objective: The present study was carried out to investigate the effect of short term high intensity aerobic exercise on lung function in adults to start first step in establishing an evidence based exercise program designed for chest patients who can only be supervised in short term hospitalization phase. Methods: A pre-post test study design was carried out on thirty healthy men students with their mean age 21.7 ± 1.26 who were enrolled in this study. Every student performed a 20-minute high-intensity monitored stationary arm Ergometer exercise and ventilatory function tests was performed in order to measure forced vital capacity (FVC), forced expiratory volume at the end of the first second (FEV1), FEV1/FVC ratio and peak expiratory flow rate PEFR before and after the exercise. Results: The result showed significant increase in the mean value of FEV1, and a non-significant difference in the mean values of (FVC), FEV1/FVC and PEFR. Conclusion: A single high intensity arm Ergometer exercise sitting has a significant effect on improving forced expiratory volume in the normal adult.3 Abstract: Immunological techniques have been developed over years using different Fasciola antigens for diagnosis of fascioliasis and as to replace the parasitological techniques which are time consuming and usually lack sensitivity and reproducibility. In this study, Fasciola gigantica purified metacercarial antigen was early detected in sera of infected sheep using both sandwich and Dot-ELISA in order to evaluate the efficacy of purified metacercarial antigen performance in diagnosing early fascioliasis. This work was conducted on 150 sheep blood samples which were classified according to their parasitological manifestation into 110 sera infected with fascioliasis, 20 infected with other different parasites and 20 healthy control sera. The sensitivity and specificity of sandwich ELISA compared to those of the Dot-ELISA were 92.7% and 93.7% versus 95.5% and 97.5%, respectively. On the other hand, the parasitological examination recorded 68.6% sensitivity and 100% specificity. The purified F. gigantica metaceraial antigens have shown a powerful antigencity for early immune-diagnosis of fascioliasis in both ELISA techniques, however, Dot- ELISA was trouble-free, more sensitive, greater specific and affordable as well as feasible test; the features recommended for any technique to be used in detecting the light infection, particularly, at the early stages that precede the onset of parasite eggs.Several factors may contribute to the rising of water-pipe smoking. Objectives: Several factors may contribute to the rising of water pipe smoking. The objectives of our study were to determine the prevalence, individual and social factors of water pipe smoking among undergraduate medical students of King Saud University in Riyadh, Saudi Arabia. Methods: A cross-sectional descriptive/analytical study was done among a representative sample of 408 male and female undergraduate medical students. A simple random sampling method was used to select the participants. Aself-administered questionnaire was constructed based on the National Youth Tobacco Survey in the United States. Multiple logistic regression analysis was performed to analyze the data. Results: The prevalence of water-pipe smoking among medical students was 11.8% for males and 2% for females. Factors associated with water pipe smoking were water pipe smoking among siblings (OR=6.6; 95% CI = 2.3 – 18.2),parents (OR=4.6; 95% CI = 1.7 – 12.0), and closefriend (OR=65.7; 95% CI = 8.8 – 490.0). The odds of water pipe smoking among the 5th year students were five times higher (OR = 5.5; 95% CI = 1.4 – 24.6) compared to other years. Students whose parents were widowed had 4.2-fold (95% CI = 1.213.7) odds of water pipe smoking compared to students with full families. Conclusion: Social determinants, such as water pipe smoking among siblings, parents and close friends, as well as individual factors such as years of a study and parental marital status were associated with water pipe smoking among undergraduate medical students. Our finding can potentially improve tobacco control programs in Saudi Arabia and decrease the prevalence of water pipe smoking among students.M tourism has transformed from a cottage industry to a sector experiencing tremendous growth and becoming a focus area for governments regionally.As the coming rise in domestic demand brings strong growth and stability to the health care industry, further expansion into the world market through medical tourism represents an untapped resource that could take the sector to a new level. However, medical tourism is a highly competitive market and the emirate is working to establish itself within a crowded field – namely from South East Asia cities, who are accelerating their push into solidify their position as hubs for medical tourism.The key to entering and establishing a foothold will be from promoting existing strengths and reaching patients across different mediums, on both a continuous basis and during the time of decision making.”Objectives: to assess the Prevalence of anxiety and depression among secondary school students and to compare male and female group Methods: This is an observational cross section study using The sampling technique followed stratified convenient sampling and data was collected using self-administered questionnaires (Arabic version of the symptom revised SCL 90- R). Data was collected from 331 secondary school students between 15 and 18 years old from both genders after raking an informed consent Results: Results show 25.7% of the students had anxiety, On comparing boys and girls,23 boys (10.1%) had anxiety, while 62 (59.6%) of the girls had anxiety. In depression 28.4% is the Prevalence of depression in both genders, on comparing boys and girls, 34 male students (14.9%), while 60 female students (57.7%) had depressive symptoms with strong significance when comparing boys to girls Conclusion: This study analyzed the importance of mental health assessment and follow-up in secondary school students, especially girls. However, further assessment for other co – factors such as socioeconomic differences should be considered.Methods: Using a previously validated questionnaire that comprises 38 questions to assess the level of knowledge, attitude and practices towards blood donation, 469 Saudi adults who attended different shopping malls in Riyadh, Saudi Arabia were interviewed. Based on calculated scores, level of knowledge and attitude of our study cohort were categorized into different groups. Multiple regression analyses were used to identify significant predictors of blood donation.Procedure: A sample of 250 postmenopausal women ranging in age between 45 to 80 years was selected by purposive sampling from various parts of north India (Haryana, Punjab, and Chandigarh). Anthropometric parameters (height, weight), physiological variables (systolic and diastolic blood pressure, pulse rate), hypertension (as per JNC VII criteria) and bone mineral density (using dual Energy X-ray Absorptiometry at lumbar spine L1-L4) of all the participants were recorded. Findings indicated that 40.4% women were identified with hypertension, out of which 12.8% had normal bone mineral density, 16.4% and 11.2% were osteopenic and osteoporotic respectively.

Noncompliance with surgical antimicrobial prophylaxis guidelines: A Jordanian experience in cesarean deliveries.

HighlightsCompliance with antibiotic prophylaxis guidelines prior cesareans was evaluated.Overall compliance and compliance with the duration of prophylaxis were poor.Compliance with indication and choice of antibiotic was high.Emergent cesareans reduced noncompliance risk with dose/time of administration.Emergent operations increased the risk of prolonging prophylaxis following surgery. Background: Surgical site infections are common, especially in developing countries. Nevertheless, up to 60% of surgical site infections can be prevented with appropriate perioperative care, which includes among other measures using suitable surgical antimicrobial prophylaxis (SAP). Methods: After a short interview with patients and retrospective review of medical charts, compliance with 6 SAP parameters was assessed for appropriateness; those parameters are indication, choice, dose, time of administration, intraoperative redosing interval, and duration of prophylaxis in 1,173 operations. Results: Overall compliance was poor; nevertheless, certain components showed high compliance rates, such as indication and choice of antibiotics. The most frequent error noted was extended administration of prophylactic antibiotics, which was observed in 88.2% of the study population. Emergency operations were associated with a lower risk of noncompliance in administering the correct dose at the correct time (odds ratio, 0.63; 95% confidence interval, 0.47‐0.83 and odds ratio, 0.21; 95% confidence interval, 0.14‐0.3, respectively). On the other hand, women who underwent an emergency operation were associated with a 6‐fold higher risk of receiving prophylactic therapy following surgery. Conclusions: The present study demonstrated the existence of a surprisingly low level of overall compliance with the hospital‐adapted SAP guidelines. Factors implicated in noncompliance were investigated, and the present results create a starting point to improve the current practice.

Adherence to 6-Mercaptopurine in children and adolescents with Acute Lymphoblastic Leukemia

Objective Studies on children with Acute Lymphoblastic Leukemia (ALL) reported non-adherence in 2–54% of cases. The primary objective of this study was to assess rates of adherence to 6-MP using two different methods in children and adolescents with ALL. Secondary aim was to identify factors that influence adherence to 6-MP in children with ALL. Methods All eligible children with ALL who are (≤ 19) years old and receive 6-MP therapy for at least 1 month were approached to participate in the study. A total of 52 children with ALL and their primary caregivers were recruited. Adherence measures included an objective method (measuring 6-MP metabolites in packed Red Blood Cells (RBCs)) and a subjective method (using parent and child self-report via the Medication Adherence Report Scale; MARS; Adherence was defined as 90% or greater). Results Rates of adherence varied across the measurement methods. Packed RBCs sample analysis indicated forty-four patients (84.6%) to be adherent. Using the MARS questionnaires, a total of 49 children (94.2%) were classified as being adherent according to the parental MARS questionnaire scores, while all the 15 children (100%) who answered the MARS (child) questionnaire were classified as adherent. Overall adherence rate was 80.8% within the studied population. Conclusion MARS scale was shown to overestimate adherence compared to measurement of 6-MP metabolites in the blood. A combination of both methods led to increased detection of non-adherence to thiopurine in children with ALL.

Predictors of nonadherence in children and adolescents with epilepsy: A multimethod assessment approach

BACKGROUND There is a lack of a standardized tool for adherence measurement in patients with epilepsy. Studies in children with epilepsy have reported adherence in 50-96.5%. The primary objective of this study was to identify predictors of nonadherence to antiepileptic drugs (AEDs) using two different methods in Jordanian children and adolescents with epilepsy. METHODS Participants included 63 children and adolescents with epilepsy and their primary caregivers. Adherence measures included a subjective approach (using parent and child self-reports via Medication Adherence Report Scale (MARS)) and an objective method (measuring plasma levels of AEDs coupled with the application of population pharmacokinetic models to predict AED concentrations in the children). The Beliefs about Medicines Questionnaire (BMQ) was used to examine the association beliefs about medicines with nonadherence in the participating patients. RESULTS Measuring AEDs in plasma samples captured the highest percentage of nonadherence (36.2%). No significant agreement was found between the AED plasma level method and both the MARS (parent) and MARS (child). The overall nonadherence (combined methods) to AED therapy in children with epilepsy was 44.4%. Logistic regression analysis indicated that children with longer duration of disease were more likely (odds ratio [OR]: 1.54, 95% confidence interval [CI]: 1.16-2.04) to be classified as nonadherent as were children whose parents have lower AED Necessity scores (OR: 0.68, 95% CI: 0.53-0.87) and higher AED Concerns (OR: 1.6, 95% CI: 1.26-2.04) as measured by the BMQ. CONCLUSION The use of a multimethod approach for assessing adherence increases sensitivity for detection of nonadherence to AEDs. Disease duration and parental necessity beliefs and concerns assessed by the BMQ-specific questionnaire were significant predictors of nonadherence to the AED therapy. The need for the development and implementation of interventions that can be employed to improve adherence within this pediatric population has been highlighted by the high levels of nonadherence identified.

Genetic Polymorphism of Thiopurine S-methyltransferase in Children with Acute Lymphoblastic Leukemia in Jordan

Background and Aims: It has been demonstrated that homozygote and heterozygote mutant allele carriers for thiopurine S-methyltransferase (TPMT) are at high risk of developing myelosuppression after receiving standard doses of 6-mercaptopurine (6-MP). The aim of this study was to determine the frequency of TPMT deficient alleles in children with acute lymphoblastic leukemia (ALL) in Jordan and to compare it with other ethnic groups. Methods: We included 52 ALL childhood cases from King Hussein Cancer Research Center in Jordan. Genotyping of the rs1800460, rs1800462, and rs1142345 SNPs was performed by polymerase chain reaction (PCR) followed by sequencing. Comparisons were made with historical data for controls and for both volunteers and cases from other middle-eastern countries. Results: Mutant TPMT alleles were present in 3.8% (2/52) of patients. Allelic frequencies were 1.0% for both TPMT*B and TPMT*C. None of the patients were heterozygous or homozygous for TPMT*3A or TPMT *2. We did not find statistically significant differences in the distribution of mutant alleles between Jordan and other middle-eastern countries for both healthy volunteers or ALL patients. Conclusions: The overall frequency of TPMT mutant alleles was low and did not exhibit differences compared to other middle-eastern countries, including Jordanian studies assessing TPMT mutant alleles in healthy volunteers. The current results question the value of TPMT genotyping in the Jordanian population.

Surgical site infections following caesarean operations at a Jordanian teaching hospital: Frequency and implicated factors

Surgical site infections (SSIs) following caesarean surgeries are common. The present study aimed to evaluate the frequency of SSIs following caesareans at Jordan University Hospital during the 30 postoperative days and to identify factors associated with increased SSIs risk. Data regarding the occurrence of SSIs were collected both prospectively via follow-up phone calls and retrospectively via reviewing wound culture results and clinical notes. SSI cases were subsequently determined utilizing predefined criteria. Data relating to possible risk factors of SSIs were collected from patient interviews and hospital records. Risk factors for SSIs were identified via logistic regression. A high rate of SSIs (14.4%) was detected; implicated factors included body mass index ≥36 kg/m2 prior to pregnancy odds ratio (OR) 3.8, 95% confidence interval (95% CI) 1.6–9.4, hospital stay longer than 3.5 days OR 2.3, 95% CI 1.4-3.6, having the operation at a gestational age greater than 40 weeks OR 2.2, 95% CI 1.3-3.9. Receiving a higher weight-adjusted dose of the prophylactic antibiotic cefazolin was associated with lower SSIs risk OR 0.967, 95% CI 0.94-0.99.In conclusion, a high rate of SSIs following caesareans was detected, and modifiable risk factors of SSIs should be incorporated into targeted policies aiming to reduce the rate of SSIs.

Chromatographic Characterization and Method Development for Determination of Levetiracetam in Saliva: Application to Correlation with Plasma Levels

Levetiracetam (LVT) is a widely used antiepileptic drug (AED). A less invasive sampling method for therapeutic drug monitoring (TDM) would be very useful particularly for children. Saliva has been shown as an adequate sample for TDM of some AEDs. Due to the high hydrophilicity of LVT its separation on common stationary phases is quite a challenge so that previous methods for determination of LVT in saliva employed either gradient high performance liquid chromatographic (HPLC) system or mass spectrometer as a detector. In this study the retention behavior of LVT on some common stationary phases was examined, with C8 being the most retentive. A simple isocratic HPLC method that is based on simple protein precipitation was developed and validated for the determination of LVT in saliva. The method was applied to a sample group of epileptic children for the purpose of assessing potential correlation with plasma LVT levels and to investigate patients compliance. The results confirmed a reasonable correlation between plasma and salivary levels of LVT (R = 0.9) which supports the use of saliva for TDM of LVT. The study also revealed a significant percentage of epileptic patients having LVT levels below the estimated therapeutic range.