Nour A. Obeidat

The acute effects of waterpipe smoking on lung function and exercise capacity in a pilot study of healthy participants

Abstract Context: Waterpipe tobacco smoking (WTS) has gained popularity, but its physiologic effects have not been extensively studied: rather, studies have focused on WTS’s chronic effects or have evaluated limited respiratory/cardiac parameters. Objective: We sought to characterize in a more detailed manner the acute effects of WTS on lung function and exercise capacity. Method: We recruited 24 healthy WTS males. We used a pilot single-group pre-test (abstained from WTS for ≥48 h) post-test (within 0.5 h of a 45-min WTS session) design. We performed spirometry, diffusing lung capacity and time-limited CPE testing (CPET; cycloergometer; 2-min 20-Watt warm-up and 25-Watt increase every 2-min for 10 min). Results: Mean age was 20.4 years; Post-WTS, the following significant changes were observed: CO level increased from 3.7 ppm to 24.4; oxygen consumption decreased (from 1.86 L/min to 1.7); baseline respiratory rate increased (from 17.7 breath/min to 19.7); forced expiratory flow over the middle half of the forced vital capacity decreased (from 5.51 L to 5.29); and perceived exertion (measured by Borg scale) at mid and peak exercise increased. Baseline resting systolic blood pressure, pulse pressure, and pulse pressure product increased post-WTS (from 118.9 mmHg to 129.2; from 45.3 mmHg to 55.6; and from 9.9 mmHg/min to 11.1 post-WTS, respectively). During exercise, a decrease in oxygen pulse was observed post-WTS (from 10.89 ml/beat to 9.97), while the heart rate-oxygen consumption relationship increased post-WTS (from 3.52 beats/ml/kg to 3.91). Conclusion: Acute WTS appears to induce impairment in lung function and exercise capacity. Larger studies are warranted to further characterize the nature and extent of such impairment.

Smoking Cessation Support Among Oncology Practitioners in a Regional Cancer Center in the Middle East—Improving a Critical Service for Cancer Care

Introduction Integration of smoking cessation (SC) services within cancer treatment is essential for ensuring better quality of care [1–3]. Unfortunately, deficiencies exist in the availing, by oncology providers, of SC services [2, 4–7]. Reasons include lack of professional education, patient resistance, and time barriers [8–10]. In Middle Eastern countries such as Jordan, a scarcity of information exists with regard to provision of SC support (SCS) among oncology practitioners. Without such information, cancer centers are unable to identify opportunities for improvement. KingHusseinCancerCenter (KHCC),which also operates a SC clinic and is a regional SC training center, is one of the few comprehensive cancer centers in the region. We thus sought, within KHCC, to study the status of providerreported performance of SCS, focusing on provision of AAR (Ask about smoking, Advice against smoking, Refer to the SC clinic, and document smoking status); factors associated with provision of AAR; and perceived roles, barriers, and facilitators of providing SCS.

Recommandations pour le traitement de la dépendance au tabac en Jordanie: Argumentation et développement

Jordan, a high tobacco-burden country, has been working to expand its tobacco dependence treatment services and has completed development of its first customized treatment guidelines. Our paper presents the development process for these guidelines. A group of national and international experts was formed and a national situation analysis for tobacco dependence treatment practices and a detailed review of international evidence were conducted. The guidelines were then drafted and reviewed by national, regional and international experts and were official endorsed by the Jordanian Ministry of Health before being launched. The guidelines comprise concise descriptions and practical supplementary flowcharts covering the major elements of general tobacco dependence treatment. These are the first comprehensive Arabic-language guidelines, including a section focusing on waterpipe use, and we believe they are a reliable and useful resource for neighbouring countries seeking to develop similar guidelines.Jordan, a high tobacco-burden country, has been working to expand its tobacco dependence treatment services and has completed development of its first customized treatment guidelines. Our paper presents the development process for these guidelines. A group of national and international experts was formed and a national situation analysis for tobacco dependence treatment practices and a detailed review of international evidence were conducted. The guidelines were then drafted and reviewed by national, regional and international experts and were official endorsed by the Jordanian Ministry of Health before being launched. The guidelines comprise concise descriptions and practical supplementary flowcharts covering the major elements of general tobacco dependence treatment. These are the first comprehensive Arabic-language guidelines, including a section focusing on waterpipe use, and we believe they are a reliable and useful resource for neighbouring countries seeking to develop similar guidelines.

Educational Needs of Oncology Practitioners in a Regional Cancer Center in the Middle East—Improving the Content of Smoking Cessation Training Programs

Little is known with regard to perceptions and information needs of oncology practitioners in the Middle East as they pertain to smoking cessation (SC) support for cancer patients. We sought to assess these in a regional cancer center. A survey was distributed to oncology practitioners (physicians, nurses, pharmacists, and physio- and respiratory therapists) at King Hussein Cancer Center (Amman, Jordan) for self-completion. The survey included SC-related measures of perceptions, knowledge, and practices. Descriptive statistics and cross tabulations were performed to identify misperceptions and knowledge gaps that could be corrected through continuing education. Findings revealed, among 254 practitioners surveyed, low referral rates to the SC clinic. Negative perceptions about cancer patients who smoke existed (e.g., patients needing smoking to control anxiety; patients’ willpower sufficient for quitting; patients not wanting to quit and not needing more information). Substantial knowledge gaps were prevalent with regard to the detrimental outcomes associated with continued tobacco use after a cancer diagnosis and with regard to approved SC medication choices. Our results are useful in identifying topics that need to be highlighted during training and educational efforts in the region and also reinforce the need to avail such efforts in order to improve SC-related knowledge and perceptions.

Public support for smoke-free policies in Jordan, a high tobacco burden country with weak implementation of policies: Status, opportunities, and challenges

ABSTRACT Several Eastern Mediterranean (EM) countries, including Jordan, suffer from high smoking prevalence but weak implementation of smoking bans (SB). Public support (PS) influences successful implementation of SB, but little is known about PS for SB in EM countries with weak SB implementation. We conducted a cross-sectional survey measuring knowledge and perceptions of a large purposive sample of the Jordanian public regarding tobacco harms and anti-tobacco laws. Among 1169 respondents, 46% of whom used tobacco, PS for SB varied from 98% to 39% based on venue, being highest for health facilities and lowest for coffee shops. In venues with relatively lower PS (restaurants, coffee shops), lower educational groups, older age groups, nonsmokers, and those who had more knowledge regarding tobacco and secondhand smoke harms were significantly more likely to support SB than the highest educational group, the youngest age group, smokers, and those who had less knowledge (respectively). Our results suggest that aggressive promotion of SB is needed in countries like Jordan (where smoking is increasing), tailored to venue and specific sociodemographic characteristics of the public accessing these venues, particularly restaurants and coffee shops. Multifaceted health messages that enhance public knowledge can be of benefit in improving PS for SB.

Rethinking anti-tobacco health education in an Eastern Mediterranean country with growing tobacco use

BACKGROUND In Jordan, a developing country with a high tobacco burden and where roughly 40% of cancers are tobacco-related, limited knowledge exists on public awareness regarding tobacco. This is a hindrance for experts seeking to strengthen anti-tobacco health promotion and counter growing tobacco use. We sought to evaluate public awareness regarding tobacco; to gauge exposure to anti-tobacco public messages; and to draw attention to the lay publics informational needs. MATERIALS AND METHODS A cross-sectional survey of lay public in the capital, Amman, capturing knowledge regarding tobacco harms and anti-tobacco laws, perceptions regarding tobacco use and control, and exposure to and recall of anti-tobacco messages, was conducted. Statistics on perceptions were generated and analyzed by smoking status and sociodemographic factors. Multivariate regression was performed to estimate independent associations of smoking and sociodemographic factors with knowledge. RESULTS Of 1,169 respondents, 17.8% could recall specific anti-tobacco messages. With regard to knowledge, despite high proportions of respondents exhibiting knowledge for individual statements regarding tobacco health harms, variables capturing breadth of knowledge showed that much lower proportions could correctly identify all the listed health harms of tobacco, and all listed Jordanian anti-tobacco regulations (47.5% and 36.2%, respectively). On multivariate analysis, breadth of knowledge varied by smoking status, age and educational level. CONCLUSIONS There is need for more salient, evocative and multi-faceted anti-tobacco messages in Jordan, tailored to subgroups, given detected variability in knowledge across smoking status and sociodemographic characteristics.

Q-Monitoring of ambulatory care in Switzerland – with the participation of the SRS!

Doctors want to ensure their patients receive the best possible treatment. With this in mind, their daily work is committed to quality assurance by means of case discussions, further training, reviewing standards of treatment etc. This commitment to quality is still insufficiently perceived by the general public and politicians, particularly in the ambulatory sector. This is where the “Q-Monitoring of ambulatory care in Switzerland” project (“Q-Monitoring”) plays an important part: using statistics, it aims to illustrate the spectrum of quality activities already being performed by doctors specializing in ambulatory treatment.