Saafan A. Al-Safi

Public knowledge and attitudes towards epilepsy in Jordan.

BACKGROUND Social acceptances of people with epilepsy very often constitute a considerable problem for patients and their family. Nationwide opinion polls on the public knowledge and attitudes towards epilepsy have been reported from several countries. The purpose of this study is to assess the knowledge and attitudes of the Jordanian public towards epilepsy, which have not been verified before. METHODS A total of 16,044 people (8158 males and 7886 females) living in different areas of Jordan were interviewed by invitation using standard four set questionnaire constructed from previous similar studies (Caveness and Gallup) that tested public knowledge and attitudes toward epilepsy. Two hundred and thirty senior students of the faculty of pharmacy at Jordan University of Science and Technology are involved in this study. Each student interviewed at least 50 individuals, aged 18 years or older, from their immediate community including family members, relatives, neighbors and friends by invitation. The interviews took place during the period from February to June of 2005. RESULTS Eighty-eight percent had read or knew about epilepsy, and 52.4% had witnessed an epileptic attack at least once in their life. From the people interviewed, 84.7% believed that the cause of epilepsy is a neurological disease, and 80.6% believe that the main symptom is brief loss of consciousness. The response of the younger participants and those with higher education were statistically significant more positive regarding the knowledge on causes and symptoms of epilepsy. More than 70% accepts shaking hands with people with epilepsy; they also believe that people with epilepsy are able to have children and to get high academic degrees. Less than 50% accepts letting their children play with children with epilepsy or employ people with epilepsy. Nine percent had negative attitudes, and believed that patients with epilepsy are insane and 88.5% objects the marriage of people with epilepsy to their sons or daughters. Approximately one third of the respondents believed that epilepsy is more dangerous than diabetes mellitus and hypertension. CONCLUSIONS The overall knowledge and attitudes of Jordanians towards epilepsy is relatively comparable with the results from Asian countries but more negative when compared with reports from the Western countries. Consequently, well-organized educational campaigns are needed to improve public perception about epilepsy.

The Use of Medicinal Herbs by Diabetic Jordanian Patients

Diabetes mellitus is the most common metabolic disorder worldwide. To date, there have been no reports on the frequency of use of herb medicines in the managements of diabetes mellitus in Jordan. This cross-sectional study was conducted by interviewing 310 diabetic patients visiting two medical centers in Jordan: Jordan University of Science & Technology Medical Center and Sarih Medical Center between December 2003 and August 2004. It is found that 31% of interviewed patients have used herbal products (96 patients). The results revealed that the most commonly used herbs by diabetic patients in Jordan were Trigonella foenumgraecum (22.9%), Lupinus albus (14.6%), Alliumm sativum (11.5%), Allium cepa (5.2%), Nigella sativa (7.3%), Zea mays L. (6.3%), Urtica dioica L. (8.3%), Eucalyptus globules LA (9.4%), Olea europea L. (3.1%), Cumminum cyminum (9.4%), Coriandrum sativum (10.4%), Salvia officinalis L. (3.1%), and Tilia cordata (1%). Furthermore, it is found that 47.9% of the patients used herbs according to advice from their friends on a daily basis. The side effects were reported by 36.5% of the patients and include headache, nausea, dizziness, itching, palpitation, and sweating. Among the patients, 72.9% used the herbs as adjunctive therapy along with their anti-diabetic drugs and 80.2% of the patients informed their physicians about their use. A 79.2% of the sample confirmed their intention to re-use these herbs as 86.5% of them were satisfied with their diabetes control. There was a significant relationship between the use of herbs, the patient’s place of residence and his/her level of education. The main conclusion of this survey is that the use of medicinal herbs among diabetic patient in Jordan is common. Therefore, it is essential to increase the level of awareness among diabetic patients and health care providers regarding the efficacy and toxicity of these medicinal herbs.

Does Smoking Affect Blood Pressure and Heart Rate

Background: Smoking is a risk factor for cardiovascular, coronary artery and thromboembolic disorders. There is overwhelming evidence supporting the association of cigarette smoking and the development of cardiovascular and thromboembolic events particularly in high risk populations. Aim: The aim of this investigation was to explore the correlation of smoking habit with blood pressure and heart rate values through a randomized cross-sectional epidemiological study in Jordan. Settings and design: This study was performed during the period of February–June 2004. The sample of this investigation included healthy adult males and females from various regions of Jordan. Most of the selected sample included Jordanian university students. Patients with hypertension or cardiovascular disorders were excluded. Methods: Selected individuals of the sample were interviewed by well-trained senior pharmacy students. They were asked initially if they have hypertension or other cardiovascular disorders and if the answer was negative, further questions were asked followed by measurement of the blood pressure and heart rate. Demographic data such as age, sex, nationality, place of residence, occupation and level of education were also recorded. Smokers (for ≥ 6 months) were asked to report how many cigarettes per day they smoke. For each individual of the sample, the systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate were measured three times with 10–15 min intervals in the sitting position and at the resting state. The arterial blood pressure (ABP) was calculated from the measured SBP and DBP. The mean values were distributed according to sex and smoking habit. Statistical analysis: The student unpaired t-test was used for statistical analysis. Results were considered statistically significant when the p value was less than 0.05. Results and conclusion: A total of 14,310 adult males (7400) and females (6910) were selected in various regions of Jordan. The frequencies of smokers and non-smokers in the sample were 3832 (26.8%) and 10478 (73.2%), respectively. Smoker males and females had significantly higher SBP, DBP, ABP values than non-smokers. However, smoking had statistically non-significant effects on heart rate in females while heart rate values were significantly higher in male smokers than in non-smokers. Smoker or non-smoker adults with a positive family history of hypertension had significantly higher blood pressure and heart rate values than those with a negative family history of hypertension. In conclusion, smokers have higher blood pressure than non-smokers.

Analysis of cadmium and lead: their immunosuppressive effects and distribution in various organs of mice.

Chronic exposure (3.5 mo) of mice to cadmium (Cd), lead (Pb), or a cadmium-lead mixture at a concentration of 1 ppm in drinking water induced a highly significant inhibition of antibody response to human serum. The highest immunosuppression (84.4%) was induced by the Cd-Pb mixture, whereas Cd caused the lowest immunosuppression (53.6%). The body burden of Cd and Pb in various organs was investigated in the four groups of mice by atomic absorption spectrometry. The highest level of Cd was found in the kidney of the Cd-treated group, and the highest level of Pb was found in the liver of the Pb- and Cd-Pb-treated groups. It is concluded that when mice are exposed concurrently to Cd and Pb, they develop synergistic immunsuppression. Analysis of Cd levels using atomic absorption spectrometry revealed that it was distributed in the following order: kidney>liver>spleen>heart, whereas Pb was distributed in the following order: liver>kidney>spleen>heart.

Public awareness of the abuse of herbs and drugs to decrease body weight: a novel national survey in Jordan

ObjectivesThe aim of this investigation was to measure the degree of public preferences regarding the various weight-loss practices and to assess the level of awareness regarding the risks and health hazards associated with the application of unhealthful measures to lose weight.MethodsApproximately 30,000 individuals selected from various regions in Jordan filled in a self−reported questionnaire. Participants were interviewed by well–trained senior pharmacy students and were asked to report their response to various aspects regarding body weight-loss practices.ResultsOf the respondents, 74.55% agreed that dietary restriction is the major intervention to lose weight. A modest majority of respondents (39.09%) believed that nervousness and irritability are serious drawbacks for uncontrolled administration of the hormone thyroxine. The highest percentage of responding females (67.12%) reported diarrhea as a major adverse effect to laxative abuse.DiscussionThe availability and the number of adverse events associated with herbal and dietary supplements to lose weight are on the rise. Obese patients should consider realistic expectations and be encouraged to follow healthy lifestyle interventions. Health care professionals are best suited to educate obese patients about unhealthy practices like laxative and diuretic abuse.

Analysis of cadmium and lead in mice organs : Effect of nigella sativa L. (Black Cumin) on the distribution and immunosuppressive effect of cadmium-lead mixture in mice

Analysis and distribution of Pb and Cd in different mice organs, including the liver, kidney, spleen, heart, and blood, were evaluated before and after treatment with different aqueous concentrations of Nigella sativa (1.25–10.0 mg/L). Atomic absorption spectrometry was used for analysis of Pb and Cd in these organs. Results indicated that the Pb in the unexposed group of mice without treatment with N. sativa (black cumin) was in the following order: liver>heart>spleen>kidney, and the distribution of Pb in various organs of the unexposed group was not affected significantly by N. sativa. Moreover, results of mice exposed for Pb show that the Pb concentrations in different organs were reduced significantly (p<0.05) by 72.9%, 63.4%, 72.3%, 66.7%, and 39.5% at a dose of 10 mg/L of N. sativa for the liver, kidney, heart, spleen, and blood, respectively. Furthermore, the distribution of Cd in the unexposed Cd group of mice without treatment with N. sativa was in the following order: kidney>heart>spleen>liver. Nigella sativa at 10 mg/L reduced Cd levels in mice exposed to Cd by 75.5%, 83.3%, 47.0%, 95.3%, and 100% in the liver, kidney, heart, spleen, and blood, respectively, whereas blood Cd concentrations were lowered to below the detection limit of 0.05 μg/L.A 28-d exposure of mice to a Cd−Pb mixture at a concentration of 1 ppm in drinking water induced a highly significant inhibition (p<0.0001) of antibody response to human serum (80.5%). The suppressed immune responses in mice pretreated with the Cd−Pb mixture were reversed by 43.1% and 38.9% in the presence of 1.25 and 2.5 mg/mL of N. sativa, respectively, whereas higher concentrations (5–10 mg/mL) of N. sativa increased the immunosuppression significantly. Nigella sativa at 1.25–10 mg/mL did not induce any significant modulation of the antibody response in unexposed mice.

Knowledge of management of epilepsy in young adults in Jordan

PURPOSE Nationwide studies on public knowledge of epilepsy have been undertaken in several countries, but not in Jordan. The purpose of this study was to evaluate knowledge of the management of epilepsy in Jordan. METHODS A cross-sectional study was performed during the period February-June 2005 on 16,044 individuals selected randomly to represent all regions of Jordan. Respondents were interviewed and asked to complete a five-item questionnaire testing their knowledge of the management of epilepsy. RESULTS Most of the individuals (77.9%) agreed that patients with epilepsy are best treated in a specialized hospital for neurological diseases. Although the largest percentage of the sample (86.7%) agreed that the best person to treat epilepsy is a neurologist, others believed that a hypnotherapist (25.4%) or a religious healer (22.6%) is. As an immediate measure during an attack of epilepsy, most respondents (82.6%) agreed that protecting the patients head is most important. During the postseizure period, 45.8% of respondents believed that offering the patient water or a cold or hot drink is appropriate. Two-thirds of the respondents (66.2%) agreed that epilepsy can be treated with drugs. Responses of the participants to the five items significantly differed with respect to age, gender, level of education, and occupation. CONCLUSION Jordanians are reasonably well informed about most aspects of the management of epilepsy, but there is still a need for public education about this disorder.

Public Response to Chest Pain in Jordan

Background: Chest pain is one of the main and most frequent manifestations of myocardial infarction (MI). Increased level of public awareness on the optimal response to chest pain due to MI attacks is crucial for minimizing its complications and mortality rate. Aims: The first aim of this investigation was to assess the level of public awareness on their response to acute chest pain. The second aim was to obtain information about self-reported risk factors for coronary heart disease and acute myocardial infarction. Settings and design: This survey was conducted in various regions of Jordan during the period of July–September 2004. A total of 4194 adults (out of 4500), 2086 males (49.7%) and 2108 females (50.3%) resident in Jordan were included in the sample. The response rate was 92.3%. Methods: Each individual of the sample who agreed voluntarily to participate in the investigation was asked to report in a questionnaire his/her possible risk factors for MI. Moreover, each person of the sample was asked “What do you do when you suffer from a severe and crushing chest pain that persists for longer than 15 min and radiates to jaws, neck or left shoulder, with sweating and paleness of the face?” The person was asked to choose one option out of 11. Statistical analysis: The frequency and percentage were determined for each investigated parameter. Results and conclusion: The highest percentage of respondents had good response by selecting the option “I go to a doctor” while the lowest percentage of respondents showed poor response by choosing the option “I use an antacid”. The remainder of responses was distributed among other options. Excellent awareness was reported by 47% of the sample. Differences in the type of responses were detected when the results were analyzed according to gender, type of job, level of education and ethnicity. Approximately half of the interviewed individuals of the sample had 2–4 clustering risk factors for developing acute MI attacks. Individuals in more than half of the sample had family history of hypertension and diabetes mellitus. It is concluded that although the type of response to chest pain in Jordan is good–excellent, more improvement is recommended since the risk to MI is relatively high. Community education campaigns may participate in increasing public health education on the optimal response to chest pain of myocardial origin.

Dark chocolate and blood pressure: a novel study from Jordan.

AIM The goal of this study was to assess the effect of dark chocolate intake on cardiovascular parameters like blood pressure and heart rate values in a normotensive population. SUBJECTS AND METHODS This is a randomized cross-sectional study involving a total of 14,310 adults that were selected from various regions of Jordan. Well-trained pharmacy students interviewed participants in the outpatient settings. Participants reported their weekly intake of dark chocolate that has been further classified into mild (1-2 bars/week), moderate (3-4 bars/week), and high intake ( > 4 bars/week). For each participant, the systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate were measured three times with (10-15) minute intervals in the sitting position and the resting state. The arterial blood pressure (ABP) was calculated from the measured SBP and DBP values. RESULTS All measured blood pressure values were significantly decreased for participants who reported higher dark chocolate consumption. Our results showed that heart rate values were not affected by variable intake of dark chocolate. In addition, increasing dark chocolate intake was associated with a significant decrease of blood pressure values in participants irrespective of the family history of hypertension or the age of the individual. However, heart rate values were unaffected. CONCLUSION Higher intake of dark chocolate can be associated with lower values of blood pressure, while its effect on heart rate values was not consistent.

Distribution of blood pressure and heart rate among adults in Jordan: a national survey.

Knowledge of population distribution of blood pressure is useful for predicting blood pressure related health burden as well as for planning prevention strategy. The aim of this investigation is to determine the distribution of systolic blood pressure (SBP), diastolic blood pressure (DBP), arterial blood pressure (ABP), and heart rate among normotensive adults resident from all regions of Jordan. This study is the first detailed description of these parameters in Jordan at a national level. A total of 14,310 adult males (7,400) and females (6,910) were selected randomly in various regions of Jordan. For each individual, the SBP, DBP, and heart rate were measured three times with 10–15-minute intervals in the sitting position and at the resting state. The ABP was calculated from the measured SBP and DBP. The mean values were distributed according to age and sex. Students t-test was used for statistical analysis. Males had significantly higher SBP, DBP, ABP, and heart rate values than females. There also was an increase of these values with advancing age. Moreover, cases of hypotension and bradycardia were higher in the female population than in males, whereas cases of hypertension and tachycardia were higher in males. Distribution of blood pressure and heart rate among adults in Jordan was determined. Cases of undiagnosed hypertension, hypotension, and an increase or a decrease in heart rate were detected through our random screening in the target population. Individuals with these abnormalities require further clinical investigations to confirm or exclude these findings.