Yousef Khader

The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013

Background The Global Burden of Diseases (GBD), Injuries, and Risk Factors study used the disability-adjusted life year (DALY) to quantify the burden of diseases, injuries, and risk factors. This paper provides an overview of injury estimates from the 2013 update of GBD, with detailed information on incidence, mortality, DALYs and rates of change from 1990 to 2013 for 26 causes of injury, globally, by region and by country. Methods Injury mortality was estimated using the extensive GBD mortality database, corrections for ill-defined cause of death and the cause of death ensemble modelling tool. Morbidity estimation was based on inpatient and outpatient data sets, 26 cause-of-injury and 47 nature-of-injury categories, and seven follow-up studies with patient-reported long-term outcome measures. Results In 2013, 973 million (uncertainty interval (UI) 942 to 993) people sustained injuries that warranted some type of healthcare and 4.8 million (UI 4.5 to 5.1) people died from injuries. Between 1990 and 2013 the global age-standardised injury DALY rate decreased by 31% (UI 26% to 35%). The rate of decline in DALY rates was significant for 22 cause-of-injury categories, including all the major injuries. Conclusions Injuries continue to be an important cause of morbidity and mortality in the developed and developing world. The decline in rates for almost all injuries is so prominent that it warrants a general statement that the world is becoming a safer place to live in. However, the patterns vary widely by cause, age, sex, region and time and there are still large improvements that need to be made.

Non-communicable diseases in the Arab world

According to the results of the Global Burden of Disease Study 2010, the burden of non-communicable diseases (cardiovascular disease, cancer, chronic lung diseases, and diabetes) in the Arab world has increased, with variations between countries of different income levels. Behavioural risk factors, including tobacco use, unhealthy diets, and physical inactivity are prevalent, and obesity in adults and children has reached an alarming level. Despite epidemiological evidence, the policy response to non-communicable diseases has been weak. So far, Arab governments have not placed a sufficiently high priority on addressing the high prevalence of non-communicable diseases, with variations in policies between countries and overall weak implementation. Cost-effective and evidence-based prevention and treatment interventions have already been identified. The implementation of these interventions, beginning with immediate action on salt reduction and stricter implementation of tobacco control measures, will address the rise in major risk factors. Implementation of an effective response to the non-communicable-disease crisis will need political commitment, multisectoral action, strengthened health systems, and continuous monitoring and assessment of progress. Arab governments should be held accountable for their UN commitments to address the crisis. Engagement in the global monitoring framework for non-communicable diseases should promote accountability for effective action. The human and economic burden leaves no room for inaction.

Oral contraceptives use and the risk of myocardial infarction: a meta-analysis

This meta-analysis of oral contraceptive use in relation to myocardial infarction is based on 19 case-control studies and 4 cohort studies that met pre-stated inclusion criteria. A comprehensive literature search was performed using the MEDLINE computerized database (for studies from January 1966 through October 2002). In addition, a manual search was performed for references cited in published original and reviewed articles. Current oral contraceptive (OC) users have an overall adjusted odds ratio (OR) of myocardial infarction (MI) of 2.48 [95% confidence interval (CI): 1.91-3.22] compared to never-users. The risk of MI for past OC users is not significantly different from that for never-users, overall OR = 1.15 (95% CI: 0.98-1.35; p = 0.096).

The association between periodontal disease and obesity among adults in Jordan.

AIM To determine the relationship between periodontitis and overweight/obesity among Jordanians. MATERIAL AND METHODS A systematic random sample of 340 persons aged between 18 and 70 years was selected from those who accompanied patients during their visit to the outpatient clinics in the medical centre of Jordan University of Science and Technology in north of Jordan. All participants underwent periodontal examination, had anthropometric measurements, and completed the questionnaire. Periodontitis was defined as presence of four or more teeth with one or more sites with probing pocket depth >or=4 mm and clinical attachment loss >or=3 mm. RESULTS Only 14% of normal weight participants had periodontal disease whereas 29.6% of overweight and 51.9% of obese participants had periodontal disease. Periodontitis was more prevalent among subjects with high waist circumference (WC) and among subjects with high waist-to-hip ratio. After adjusting for important variables, only body mass index (BMI)-defined obesity [odds ratio (OR)=2.9, 95% confidence interval (CI): 1.3, 6.1], high WC (OR=2.1, 95%CI: 1.2, 3.7), and high fat per cent (OR=1.8, 95% CI: 1.03, 3.3) remained significantly associated with increased odds of periodontitis. CONCLUSION BMI-defined obesity, high WC, and high fat per cent were significantly associated with increased odds of having periodontitis.

Sexual Dysfunction in Jordanian Diabetic Women

OBJECTIVE—To estimate the prevalence of female sexual dysfunction (FSD) in diabetic and nondiabetic Jordanian women. RESEARCH DESIGN AND METHODS—Data were collected from 1,137 married women using the Arabic translation of the Female Sexual Function Index questionnaire. RESULTS—Prevalence of sexual dysfunction in diabetic women 50 years of age or older was 59.6 vs. 45.6% in nondiabetic women (P = 0.003). Diabetic women had more dysfunction of desire, arousal, lubrication, and orgasm than nondiabetic women. Glycemic control, smoking, dyslipidemia, hypertension, autonomic neuropathy, and peripheral neuropathy did not have a significant effect on FSD. Age, BMI, duration of diabetes, and the presence of coronary artery disease, nephropathy, and retinopathy had negative effects on FSD. CONCLUSIONS—Prevalence of FSD among Jordanian women was found to be significantly higher in diabetic compared with nondiabetic women.

Patterns of water-pipe and cigarette smoking initiation in schoolchildren: Irbid longitudinal smoking study.

INTRODUCTION Tobacco use remains a major public health problem worldwide. Water-pipe smoking is spreading rapidly and threatening to undermine the successes achieved in tobacco control. METHODS A school-based longitudinal study in the city of Irbid, Jordan, was performed from 2008 to 2010. All seventh-grade students in 19 randomly selected schools, out of a total of 60 schools in the city, were enrolled at baseline and surveyed annually. RESULTS Of the 1781 students enrolled at baseline 1,701 (95.5%) were still in the study at the end of the second year of follow-up (869 boys, median age at baseline 13 years). Ever and current water-pipe smoking were higher than those of cigarette smoking at baseline (ever smoking: 25.9% vs. 17.6% and current smoking: 13.3% vs. 5.3% for water-pipe and cigarette smoking, respectively; p < .01 for both) but cigarette smoking caught up by the second year of follow-up (ever smoking: 46.4% vs. 44.7%; p = .32 and current smoking: 18.9% vs. 14.9%; p < .01). Water pipe-only smokers at baseline were twice as likely to become current cigarette smokers after 2 years compared with never smokers (relative risk (RR) = 2.1; 95% CI = 1.2, 3.4). A similar pattern was observed for cigarette-only smokers at baseline (RR = 2.0; 95% CI = 0.9, 4.8). CONCLUSIONS Prevalence of water-pipe and cigarette smoking increased dramatically over the 2-year follow-up period with similar patterns in boys and girls, although girls had lower prevalence in all categories. Water-pipe smoking at baseline predicted the progress to cigarette smoking in the future and vice versa.

Prevalence of Metabolic Syndrome According to Adult Treatment Panel III and International Diabetes Federation Criteria: A Population-Based Study

OBJECTIVE The objective of the study was to examine the prevalence of metabolic syndrome among adult Qatari population according to the revised criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) and the International Diabetes Federation (IDF), assess which component contributed to the increased risk of the metabolic syndrome, and identify the characteristics of the subjects with metabolic syndrome. DESIGN This was a cross-sectional study. SETTING The survey was carried out in urban and semiurban primary health-care centers. SUBJECTS AND METHODS The survey was conducted from January, 2007, to July, 2008, among Qatari nationals above 20 years of age. Of the 1496 subjects who were approached to participate in the study, 1204 (80.5%) gave their consent. Face-to-face interviews were conducted using a structured questionnaire followed by laboratory tests. Metabolic syndrome was defined using the NCEP ATP III as well as IDF criteria. RESULTS The overall prevalence of metabolic syndrome in studied subjects was 26.5% and 33.7% according to ATP III and IDF criteria (P < 0.001). The prevalence of metabolic syndrome by ATP III and IDF increased with age and body mass index (BMI), whereas it decreased with higher education and physical activity. Also, the prevalence of metabolic syndrome was more common in women. Among the components of metabolic syndrome, central obesity was significantly higher in the studied subjects. The IDF definition of metabolic syndrome gave a higher prevalence in all age groups. The overall prevalence of metabolic syndrome and its components according to IDF criteria was higher in the studied subjects than the estimates given by the ATP III. Multivariate logistics regression analysis (ATP III and IDF) showed that age and BMI were significant contributors for metabolic syndrome. Both definitions strongly supported age and obesity as associated factors for metabolic syndrome. CONCLUSIONS The current study found a high prevalence of metabolic syndrome among Qataris. There was a steady increase in the prevalence of metabolic syndrome through the decades, independent of the definition. Age and BMI were important significant predictors for metabolic syndrome.

Multiple sclerosis in Jordan: a clinical and epidemiological study

ObjectivesTo characterize the clinical, demographic and epidemiological features of multiple sclerosis (MS) in Jordan.MethodsData for consecutive Jordanian patients, fulfilling the McDonald criteria for clinically definite and clinically probable MS, during the time period 2004–2005 were collected and analyzed in the three major referral centers for MS in Jordan.ResultsWe identified a total of 224 patients (165 females, 87%; 59 males, 13%). The mean (±SD) age of onset was 29.3 (±9.6) years, and mean (±SD) duration of illness was 3.9 (±9.3) years. The prevalence of MS in the city of Amman was 39/100,000. The prevalence of MS in Irbid, north Jordan, was 38/100,000. The most frequent presentation was weakness (30.8%), followed by optic neuritis (20.1%), sensory impairment (19.6%), and ataxia (14.3%). A relapsing remitting pattern was identified in 90.2% of patients, the rest being primary and secondary progressive, and one patient had a progressive relapsing course. Family history of MS was found in 9.4% of the cases. About 60% of the patients were using interferon beta. The degree of physical disability was determined using the Expanded Disability Status Scale (EDSS). Younger age of onset, shorter duration of illness, a relapsing remitting pattern, and use of interferon were identified as statistically significant predictors of less disability.ConclusionJordan is a medium-high risk country for MS, with prevalence higher than what has previously been reported, possibly representing an increase in incidence. Clinical and demographic characteristics are similar to most reports worldwide.

Prevalence and risk indicators of gingivitis and periodontitis in a Multi-Centre study in North Jordan: a cross sectional study

BackgroundThere are limited data about the epidemiology and risk factors/indicators of gingivitis, aggressive periodontitis (AgP) and chronic periodontitis (CP) in Jordan. The aim of this study was to assess the prevalence and risk indicators of gingivitis, AgP and CP.MethodsA sample of 595 subjects was randomly selected from subjects escorting out-patients attending a Medical Center, a Dental Teaching Hospital, and 2 private dental clinics. The socio-demographic variables, oral hygiene habits, income, smoking and Body Mass Index (BMI) were recorded. Full mouth periodontal examination was performed, and radiographs were taken for sites with probing depth > 3 mm.ResultsAbout 76% had gingivitis, 2.2% had AgP and 5.5% had CP. Periodontitis was more frequent among males than females with a M: F ratio of 1.6:1 and the prevalence increased with age. Subjects who reported not using a tooth brush, smokers and subjects with BMI > 30 kg/m2 had significantly higher prevalence of periodontitis. The risk for periodontitis was greater among subjects who reported positive family history and subjects with ≤ 12 years of education.ConclusionsThis is the first study to report on the prevalence of gingivitis, CP and AgP in North Jordanian. Age, low education, low frequency of tooth brushing and family history were significantly associated with increased risk of periodontitis.

Association Between Periodontal Disease and Osteoporosis in Postmenopausal Women in Jordan

BACKGROUND Some studies suggest that females with osteoporosis are at an increased risk of periodontal attachment loss and tooth loss; however, results have varied. The aim of this study is to determine the relationship between periodontitis and osteoporosis among postmenopausal Jordanian women. METHODS This cross-sectional study includes 400 Jordanian postmenopausal women with a mean age of 62.5 years (SD ± 6.4 years). These subjects were recruited from patients who had received a routine dual-energy x-ray absorptiometry examination in the Radiology Department, King Abdullah Hospital, Jordan University of Science and Technology, between June 2008 and February 2009. The relationship between skeletal bone mineral density (BMD) and radiographic and clinical parameters of periodontal status, including the loss of alveolar crestal height (ACH), clinical attachment level, probing depth, and percentage of sites with bleeding on probing, was evaluated after controlling for known confounders. RESULTS Bivariate analyses revealed no significant differences in the severity and extent of clinical attachment and ACH loss among women with normal BMD, osteopenia, and osteoporosis. However, in the multivariate analysis, women with osteoporosis were more likely to have severe ACH loss (odds ratio [OR]: 4.20; 95% confidence interval [CI]: 1.57 to 11.22) and periodontitis (OR: 2.45; 95% CI: 1.38 to 4.34). CONCLUSION Osteoporosis was significantly associated with severe alveolar crestal bone loss and the prevalence of periodontitis cases in postmenopausal Jordanian women.