Background: Hypertension is the second most common cause of chronic kidney disease (CKD). Therefo... more Background: Hypertension is the second most common cause of chronic kidney disease (CKD). Therefore, the aims of the study were to assess the knowledge, attitudes and practices (KAP) of hypertensive patients towards prevention and early detection of CKD, and to determine the clinical and socio-demographic factors, which affect the KAP regarding prevention of CKD. Methods: A cross-sectional study was held using the CKD screening Index to assess the KAP of 374 hypertensive patients who were selected from multiple primary healthcare centers in Nablus, Palestine. The CKD Screening Index is formed of three scales. First, the knowledge scale was a dichotomous scale of 30 items, while the attitude scale used 5-point Likert-type scale for 18 items and finally the practice scale was measured using 4-point Likert-type scale for 12 items. Multiple linear regression analysis was used to determine the association between clinical and socio-demographic factors and practices. Results: In total, 374 hypertensive patients participated in the study. The mean age of participants was 59.14 ± 10.4 years, (range 26-85). The median (interquartile range) of the knowledge, attitude, and practice scores of hypertensive patients towards prevention and early detection of CKD were 20 (16-23), 69 (65-72), and 39 (36-42), respectively. In multiple linear regression analysis, patients age < 65 years (p < 0.001) and patients with high education level (p = 0.009) were the only factors significantly associated with higher knowledge scores. Additionally, patients age < 65 years (p = 0.007), patients with high income (p = 0.005), and patients with high knowledge score (p < 0.001) were the only factors significantly associated with higher attitude scores. Furthermore, regression analysis showed that patients with higher total knowledge (p = 0.001) as well as higher total attitudes scores towards CKD prevention (p < 0.001), male gender (p = 0.048), and patients with normal body mass index (BMI) (p = 0.026) were statistically significantly associated with higher practice score towards CKD prevention. Conclusions: Among hypertensive patients, higher scores for total knowledge and attitudes toward prevention, male sex, and normal BMI were associated with modestly higher scores for prevention practices. Finally the findings may encourage healthcare workers to give better counseling to improve knowledge.
Background Diabetes mellitus (DM) is one of the main noncommunicable diseases encountered in prim... more Background Diabetes mellitus (DM) is one of the main noncommunicable diseases encountered in primary health care clinics. DM is considered one of the most common causes of chronic kidney disease (CKD). In this study, we aimed to assess the knowledge, attitudes, and practices (KAP) of patients with DM on the early detection and prevention of CKD, determine its relationship with other variables, and examine the relationship between KAP scores for the prevention and early detection of CKD and the Michigan Diabetic Knowledge Test. Methods We collected data from 2 Nablus primary healthcare centers using a questionnaire that contains three sections: sociodemographic section, questions related to DM, and CKD screening index, which is formed of three scales. We used the Michigan Diabetic Knowledge Test (MDKT) to assess the knowledge of diabetic patients. Results The study was carried out among 386 diabetic patients with a mean age of 57.62 ± 12.4 years (ranging from 28 to 90). The median (i...
Introduction: Depression or anxiety are associated with survival in heart failure (HF); however, ... more Introduction: Depression or anxiety are associated with survival in heart failure (HF); however, whether co-morbid symptoms of anxiety and depression are associated with survival in patients with HF is unknown. Hypothesis: Co-morbid symptoms of depression and anxiety are more strongly associated with all-cause mortality in patients with HF compared to those with anxiety or depression alone. Methods: A total of 1,260 HF patients participated and were followed for mortality outcomes for 12 months. The Patient Health Questionnaire (PHQ-9) and Brief Symptom Inventory-anxiety subscale (BSI) were used to measure symptoms of depression and anxiety. Cox regression analysis was used to determine whether co-morbid symptoms of depression and anxiety independently predicted all-cause mortality controlling for age,gender, ethnicity, and NYHA class. Depression and anxiety were treated first as continuous level variables, then as categorical variables using standard published cut points. Patients ...
Background: The impact of pre-existing chronic kidney disease (CKD) and acute kidney injury (AKI)... more Background: The impact of pre-existing chronic kidney disease (CKD) and acute kidney injury (AKI) on health outcomes in critically ill patients is unclear. Yet, CKD complicated by AKI in critically ill patients is common. Objectives: : To compare risk of death within one-month of admission in critically ill patients with and without pre-existing CKD who developed AKI. Methods: A multicenter retrospective comparative study using medical records review was conducted. Study participants consisted of 826 adult patients who received mechanical ventilation for at least 6 h in the critical care units from January 2012 to December 2017. Assessment of kidney function was established by serum creatinine. Severity and staging of AKI were defined using RIFLE criteria: Risk, Injury, Failure, Loss and End stage of renal disease. Chronic kidney disease was defined as eGFR > 60 ml/mg/1.73 m 2 on admission. Results: Pre-existing CKD was present in 55% of patients and 7% had AKI within 7 days of admission. The overall mortality rate among these patients was 87.3%. The mortality rate was highest in patients with CKD (70.1%) followed by that of patients without pre-existing CKD but with AKI (20.7%) and that of patients with pre-existing CKD (7.1%) and AKI. Risks associated with mortality were APACHE II score (1.03; 95% CI 1.02À1.05;(P<0.001) and AKI (1.68; 95% CI 1.12À2.5;P<0.01) in patients with pre-existing CKD. Only APA-CHI-II (1.03; 95% CI 1.0À1.1; p < 0.001) was predictive of death in patients without pre-existing CKD. Conclusion: : Pre-existing comorbid CKD increases risks of death among critically ill patients compared to patients without CKD and regardless of whether they develop AKI or not. Early identification of CKD and recognition of the risk for mortality among these patients may result in earlier intervention that could reduce mortality.
Commentary on: Jones DJ, Harvey K, Harris JP, et al. Understanding the impact of haemodialysis on... more Commentary on: Jones DJ, Harvey K, Harris JP, et al. Understanding the impact of haemodialysis on UK National Health Service patients' well-being: A qualitative investigation. J Clin Nurs . 2017; 27:193-204. ESRD is the advanced stage of chronic kidney disease and results when patients require renal replacement therapy. It is …
Purpose: The purpose of this study was to identify the relationship between spiritual well-being ... more Purpose: The purpose of this study was to identify the relationship between spiritual well-being (meaning/peace, and faith) and depression among Jordanian patients receiving hemodialysis. Methods: Cross-sectional descriptive correlation design was used to carry out on a nationally representative convenience sample of 158 patients receiving hemodialysis at five different hospitals in Jordan. Results: The mean total score of the depression was 17.8 of the 40. While the mean total score of the spiritual well-being was 36.9 of the 48. The Pearson's correlation coefficient test showed significant negative correlation between spiritual well-being and depression (r = −.64, p < .005). Conclusion: Healthcare providers should consider spiritual well-being in their assessment and interventions by helping the patients to establish meaning, peace, and faith to reduce patients' depression.
OBJECTIVE This study assessed the possible association of serum brain-derived neurotrophic factor... more OBJECTIVE This study assessed the possible association of serum brain-derived neurotrophic factor (BDNF) and interleukin-6 (IL-6) with depressive and anxiety symptoms in hemodialysis (HD) patients. METHOD An analytical cross-sectional study was conducted over 274 HD patients from March to October 2017. The Hospital Anxiety and Depression Scale (HADS) was utilized to evaluate depressive (HADS-D) and anxiety (HADS-A) symptoms. The HADS-D/A is a self-report instrument that has a maximum score of 21. Serum BDNF and IL-6 were measured using enzyme-linked immunosorbant assay (ELISA). RESULTS Serum IL-6 was significantly higher in patients with depressive symptoms compared to normal (20.47 ± 4.27 pg/mL for HADS-D ≥11 versus 9.26 ± 1.59 pg/mL for HADS-D <7, p = 0.014). Multivariable regression analysis revealed that IL-6, education level, hypertension, and dialysis duration were significant predictors of HADS-D. Also, gender, education level, hypertension, and the number of dialysis sessions/week were significant predictors of HADS-A. Significant positive correlation was shown between HADS-D and IL-6 (r = 0.1729, p = 0.004). CONCLUSION Collectively, HD patients with depressive symptoms showed higher levels of IL-6, supporting previous findings that the circulating inflammatory mediator IL-6 can be used as a biomarker for prediction of depressive symptoms in HD patients. Further longitudinal or interventional studies are needed to further validate this association.
Progress in Neuro-Psychopharmacology and Biological Psychiatry, 2019
Psychological symptoms are prevalent in hemodialysis (HD) patients. Previous investigations showe... more Psychological symptoms are prevalent in hemodialysis (HD) patients. Previous investigations showed that brain-derived neurotrophic factor (BDNF) and interleukin-6 (IL-6) as well as the interaction with neuropeptide S receptor 1 (NPSR1) are linked to the development of psychological distress. This study examined the association of polymorphisms of genes encoding these proteins with depression and anxiety in a representative group of Jordanian HD patients. Methods: A total of 302 HD patients were involved in the study and categorized into three groups based on the Hospital Anxiety and Depression Scale, HADS-D or HADS-A scores as follows: normal (<7), mild (8-10) and moderate-severe (11 to 21). Single nucleotide polymorphism (SNP) of NPSR1 Asn107Ile (rs324981), IL-6 G174C (rs1800795), and BDNF Val66Met (rs6265) was genotyped using blood samples. Results: The frequency of Ile-allele of NPSR1 Asn107Ile was significantly higher in patients with moderate-severe HADS-A scores versus normal (53% vs. 40.8%, p=0.035). Using ordinal regression analysis, Asn-allele of NPSR1 polymorphism was nominally significantly associated with a lower risk of anxiety (OR=0.57, CI: 0.33-0.97, p=0.038) after adjusting for other covariates. A marginally significant difference in genotype distribution of IL-6 G174C was observed among patients according to HADS-D scores (p=0.05). Furthermore, carriers of IL-6 174 CC genotype showed lower median IL-6 serum concentration versus carriers of GG genotype (5.2 vs. 1.35 pg/mL, p<0.05). Conclusions: The results support the genetic role of NPSR1 in the pathogenesis of anxiety and suggest that carriers of NPSR1 Ile-allele are at increased risk of anxiety in HD patients. Neither BDNF Val66Met nor IL-6 G174C were linked to psychological symptoms. Future studies among other ethnicities are necessary to verify the observations.
Background: Surviving a warzone inflicts harmful consequences on the physical health and the psyc... more Background: Surviving a warzone inflicts harmful consequences on the physical health and the psychosocial wellbeing of children. This study aimed at exploring the physical and psychosocial perceived state of health of displaced Syrian refugee children in Jordan. Methods: A cross-sectional explorative design was applied. Structured questionnaires were used to collect data through face-to-face interviews with 250 Syrian refugee children. Descriptive and inferential statistics were used. Results: Children had fair levels of physical health; their health concerns were minor. Psychosocially, 25% (n = 63) suffered from loneliness and 24% (n = 59) reported feeling depressed. The majority of children (>60%) had low rates of somatic pain. Age had a negative correlation with hyperactivity (r = À.14, p = .034); gender differences were found in anger expression and anger trait (p < .05). Conclusions: The results in this study highlight a number of physical and psychosocial health concerns among refugee children. The health needs of displaced Syrian children need to be addressed using comprehensive assessment and care. Our findings documented the physical and psychosocial health needs of the displaced Syrian children in Jordan and addressed areas of focus to guide health promotion interventions and community health efforts for them. Key Practitioner Message • The wellbeing of the refugee children is a genuine community health concern. • The vast mental, emotional, behavioral, and social health concerns of Syrian refugee children need to be recognized and supported by humanitarian and organizational services. • The health care services provided require comprehensive and multidimensional approaches to address the psychosocial as well as the physical health needs of the Syrian refugee children in camps and host communities. • Access to comprehensive psychological support is essential as early as possible after displacement to support smooth atraumatic transition of the refugee children into the host community. • Skilled, well trained, and specialized health care providers are crucial to provide quality comprehensive health care services to refugee children.
Background: Jordan has no relevant database or registry by which chronic kidney disease (CKD) wou... more Background: Jordan has no relevant database or registry by which chronic kidney disease (CKD) would be early identified. The purpose of the present study is to uncover the prevalence of CKD in a national sample of Jordanian patients at high risk and examine the association of CKD with demographic and clinical factors. Methods: This is a cross-sectional, correlational study that involved 540 outpatients at high risk for CKD. Demographic and clinical data were obtained in the period from September 2013 to March 2014. Prevalence of CKD was defined based on the National Kidney Foundation Kidney Disease Outcomes Quality Initiative Classification of CKD using estimated glomerular filtration rate. Associations of CKD and demographic and clinical factors were examined using bivariate analysis. Results: The majority of the sample were females (64%), their mean age (AESD) was 55.0 AE 12.5 years, their mean eGFR (AESD) was 116.0 AE 47.5. One third of patients had eGFR of 23.5%, 5.4%, 0.7% and 0.7% which corresponds with mild, moderate, severe and very severe reduction in eGFR, respectively. Ageing, being male, unemployment, packs/years of smoking, comorbidities [hypertension (HTN), diabetes mellitus (DM) and cardiovascular disease] and low high density lipoprotein (HDL) correlated positively with development of CKD. Conclusion: This study demonstrates a high rate of under-diagnosed CKD among Jordanians. Several demographic and clinical factors are linked with the development of CKD. Policymakers and healthcare providers need to establish an evidence-based practice project to prevent and screen for CKD in Jordan.
International Nursing Review En Espanol Revista Oficial Del Consejo Internacional De Enfermeras, 2014
Objetivo: Describir el conocimiento, las actitudes y las practicas de pacientes jordanos con enfe... more Objetivo: Describir el conocimiento, las actitudes y las practicas de pacientes jordanos con enfermedades cro~ nicas hacia la prevencion y deteccion temprana de la insuficiencia renal cronica. Antecedentes: Los pacientes con enfermedades cronicas como hipertension y diabetes necesitan adoptar actitudes y practicas saludables y lograr conocimientos sobre la prevencion y deteccion temprana de la insuficiencia renal para disminuir la prevalencia de complicaciones y costes relacionados con la dialisis. Metodos: Un total de 740 pacientes fueron seleccionados en clinicas de pacientes ambulatorios en Jordania. Los conocimientos, las actitudes y las practicas sobre la prevencion y deteccion temprana de la insuficiencia renal se midieron utilizando el Indice de Deteccion de Insuficiencia Renal Cronica, que fue desarrollado por el in vest igador y probado para validez y fiabilidad. Resultados: Los resultados revelaron que la mayoria de los participantes tienen conocimientos sobre la insuficiencia renal; sin embargo, la mitad de ellos tenian informacion incorrecta relacionada con los signos y sintomas de insuficiencia renal cronica. La mayoria de participantes no eran conscientes de la importancia de descubrir los problemas de salud en las etapas tempranas. Conclusion e implicaciones: Es necesario mejorar la comprension de la poblacion sobre la insuficiencia renal cronica para avanzar en su concienciacion y practicas para tomar decisiones oportunas relacionadas con la promocion de la salud y una mejor calidad de vida. Implicaciones para el desarrollo de normativas: Las enfermeras deben participar en el desarrollo de protocolos para los programas de deteccion e intervencion, tener en cuenta las cuestiones culturales y la situacion economica de las personas en riesgo de enfermedad renal. Los gobiernos deberian adoptar una politica de salud publica para la insuficiencia renal cronica que apoye los programas de deteccion y los programas para mejorar la conciencia publica para la prevencion de la insuficiencia renal.
Regular physical activity has been associated with reduced cardiovascular disease (CVD) risk fact... more Regular physical activity has been associated with reduced cardiovascular disease (CVD) risk factors; however, a decrease in the amount of time spent during the remainder of the day in sedentary behavior may be equally important. The aim of this study was to examine the effects of a decrease in sedentary behavior on CVD risk factors among 205 individuals living in rural Appalachia. All participants received a comprehensive CVD risk reduction lifestyle intervention and measurement of major CVD risk factors and physical activity levels. Participants were divided into: 1) Adopters: those who decreased their sedentary behavior by 30 min or more per day post-intervention and 2) Non-adopters: those who did not. Repeated measures analysis of variance showed a significant group by time interaction showing that Adopters had a greater reduction in body weight and BMI than Non-adopters. These findings demonstrate that decreasing sedentary behavior is important for achieving optimal body weight.
Qualitative investigators have suggested that symptom incongruence, or a mismatch between symptom... more Qualitative investigators have suggested that symptom incongruence, or a mismatch between symptoms that patients expect and those they experience in acute myocardial infarction (AMI), increases the time to hospitalization by affecting emotional, cognitive, and behavioral factors. No quantitative studies have been conducted that verify these relationships. We aimed to (a) examine the relationships among symptom incongruence, prehospital delay, anxiety level at onset of symptoms, perceived seriousness and importance of symptoms, source to which symptoms were attributed, and patients' first response at symptom onset and (b) test the independent association of symptom incongruence to prehospital delay. Jordanian patients with AMI (n = 299) were interviewed using validated questionnaires, and medical records were reviewed to collect information on patients' prehospital delay time, symptom incongruence, and response to AMI symptoms. Patients had low mean (7.5 ± 3.6) symptom incong...
Purpose: To explore Jordanian chronic illnesses patients' perceived exercise self-efficacy, benef... more Purpose: To explore Jordanian chronic illnesses patients' perceived exercise self-efficacy, benefits and barriers, and commitment to exercise planning, and to assess the relationship between those variables. Design: Descriptive cross-sectional design. Methods: Data were collected from a convenience sample of 402 outpatient Jordanians with chronic illnesses, using Exercise Self-Efficacy Scale, Exercise Benefits and Barriers Scale, and Commitment to a Plan for Exercise Scale. Findings: The average BMI was 28.3, and exercise period 3.2 hours/ week. Participants reported moderate perceived self-efficacy (M= 47.5%, SD= 11.7), commitment to exercise planning (M=2.0/3, SD=0.3), exercise barriers (M=2.4/ 4, SD=0.3), and benefits (M=2.3/4, SD=0.3). Commitment to exercise planning had a significant correlation with barriers (r=0.11) and benefits (r=0.10). Selfefficacy was not found to correlate with other variables. Conclusions: Even though participants reported higher perceived self-efficacy and commitment to exercise plan than that reported in literature, they were found to be overweight and inactive, which indicates the importance of such study. Exercise education programs are needed taking into considerations patients' individual differences. However, the broad grouping of diseases may not produce a homogenous sample, for which disease categories are recommended in future studies. Clinical Relevance: Patients with chronic illness need more encouragement to engage themselves in exercise practices. Exercise educational program for patients with chronic illnesses should consider patients' reported exercise benefits and barriers.
Purpose: To investigate Jordanian end-stage renal disease (ESRD)patients' perceived exercise bene... more Purpose: To investigate Jordanian end-stage renal disease (ESRD)patients' perceived exercise benefits and barriers, and their correlation with patients' demographic variables and dialysis measures. Methods: A descriptive correlational study was conducted using cross-sectional survey, using a convenience sample of 190 ESRD dialyzed patients who were recruited from eight hospitals in Jordan. Findings: Participants significantly perceived exercise benefits (M= 2.88/4, SDAE .67) higher than barriers (M= 2.66, SDAE .62). The most frequent perceived exercise benefits were preventing muscular atrophy and improving mood, whereas tiredness and lower-extremity fatigue were the most frequent exercise barriers. Finally, acceptable values of Cronbach's Alpha were revealed for perceived exercise subscale, barriers subscale, and total scale (a= .88, .81, and .70, respectively). Conclusion: Participants focused more on exercise benefits than barriers, and on direct exercise benefits and barriers than the indirect. Clinical Relevance: The results of this study have important implications for the efforts that aim at improving ESRD patients' exercise behaviors.
Background and objective: Breast cancer is the most common malignancy among women worldwide, diag... more Background and objective: Breast cancer is the most common malignancy among women worldwide, diagnosis and treatment and the months following primary therapy associated with different psychological symptoms that affect quality of life (QoL) in most women with breast cancer. The aim of this study was to identify the relationship between depression and quality of life QoL among Saudi women with breast cancer.Methods: Design: This is a descriptive, cross-sectional study. Methods: A convenience sample of 370 women with breast cancer was recruited from the out-clinic in King Faisal Specialist Hospital \& Research Center (KFSH&RC). Data were collected using self-report tools derived from the Patient-Reported Outcomes Measurement Information System (PROMIS) Emotional Distress-Depression-Short Form; the EORTC quality of life questionnaire (QLQ) (EORTC QLQ-C30, v.3.0 and EORTC QLQ-BR23); and from the Demographic and Clinical Data Sheet.Results: The correlation between depression and global h...
The current study aimed to examine the effect of depressive and anxiety symptoms on physical and ... more The current study aimed to examine the effect of depressive and anxiety symptoms on physical and psychological quality of life (QOL) in end-stage renal disease patient-family caregiver dyads using the Actor-Partner Interdependence Model. This was a descriptive cross-sectional study. Dyads' (N = 120) symptoms of anxiety and depression and QOL were assessed via the Hospital Anxiety and Depression Scale and the World Health Organization (WHO)QOL-BREF, respectively. The depression scores were higher (worse) in patients than in caregivers (8.74 AE 5.23 vs. 6.9 AE 3.9, t[df 119] = 3.339, p = .001). Patients had lower (worse) scores on the physical domain of QOL than the caregivers (47.37 AE 22.9 vs. 64.1 AE 17.49, t[df 119] = −7.165, p < .001). Anxiety and depressive symptoms exhibited actor effects on the physical and psychological QOL of the dyad. Only depressive symptoms in caregivers exhibited a partner effect on the psychological domain of QOL in patients (β = −.745, p < .05). In conclusion, anxiety and depressive symptoms in both patients and caretakers are equally crucial in end-stage renal disease management.
Purpose: The review aimed to find the best evidence on the relationship between health literacy, ... more Purpose: The review aimed to find the best evidence on the relationship between health literacy, self-care behavior and perceived quality of life (QoL) among patients with acute coronary syndrome (ACS). Methods: Searching engines included Cumulative Index to Nursing Allied Health Literature (CINAHL), Pro Quest, MEDLINE, Google Scholar, SAGE Journals, Wiley on Line Library, and Science Direct electronic databases from 2010 to 2018. Fifteen research articles assessed the main variables and their associations with demographic and clinical variables. Results: Different methodologies and samples were analyzed: analytic descriptive, systematic review, a randomized control trial, retrospective cohort, a prospective Cohort, cross-sectional, and correlational designs. The fifteen studies showed that the patients with ACS have inadequate health literacy. Patients' ability to understand basic and complex information or to accurately assess health risks was impaired and may hinder patients' engagement in self-care. Low HL in patients having ACS is consistently associated with poor QoL. Physical domain of QoL remained the significant outcome of both self-care behavior and health literacy after adjusting for demographics and clinical variables in patients with ACS. Conclusion: The literature pointed to the importance of considering health literacy and self-care behaviors as predictors of quality of life among patients with ACS. However, there has been no previous evidence on the best process of the association between these three variables.
Background: Hypertension is the second most common cause of chronic kidney disease (CKD). Therefo... more Background: Hypertension is the second most common cause of chronic kidney disease (CKD). Therefore, the aims of the study were to assess the knowledge, attitudes and practices (KAP) of hypertensive patients towards prevention and early detection of CKD, and to determine the clinical and socio-demographic factors, which affect the KAP regarding prevention of CKD. Methods: A cross-sectional study was held using the CKD screening Index to assess the KAP of 374 hypertensive patients who were selected from multiple primary healthcare centers in Nablus, Palestine. The CKD Screening Index is formed of three scales. First, the knowledge scale was a dichotomous scale of 30 items, while the attitude scale used 5-point Likert-type scale for 18 items and finally the practice scale was measured using 4-point Likert-type scale for 12 items. Multiple linear regression analysis was used to determine the association between clinical and socio-demographic factors and practices. Results: In total, 374 hypertensive patients participated in the study. The mean age of participants was 59.14 ± 10.4 years, (range 26-85). The median (interquartile range) of the knowledge, attitude, and practice scores of hypertensive patients towards prevention and early detection of CKD were 20 (16-23), 69 (65-72), and 39 (36-42), respectively. In multiple linear regression analysis, patients age < 65 years (p < 0.001) and patients with high education level (p = 0.009) were the only factors significantly associated with higher knowledge scores. Additionally, patients age < 65 years (p = 0.007), patients with high income (p = 0.005), and patients with high knowledge score (p < 0.001) were the only factors significantly associated with higher attitude scores. Furthermore, regression analysis showed that patients with higher total knowledge (p = 0.001) as well as higher total attitudes scores towards CKD prevention (p < 0.001), male gender (p = 0.048), and patients with normal body mass index (BMI) (p = 0.026) were statistically significantly associated with higher practice score towards CKD prevention. Conclusions: Among hypertensive patients, higher scores for total knowledge and attitudes toward prevention, male sex, and normal BMI were associated with modestly higher scores for prevention practices. Finally the findings may encourage healthcare workers to give better counseling to improve knowledge.
Background Diabetes mellitus (DM) is one of the main noncommunicable diseases encountered in prim... more Background Diabetes mellitus (DM) is one of the main noncommunicable diseases encountered in primary health care clinics. DM is considered one of the most common causes of chronic kidney disease (CKD). In this study, we aimed to assess the knowledge, attitudes, and practices (KAP) of patients with DM on the early detection and prevention of CKD, determine its relationship with other variables, and examine the relationship between KAP scores for the prevention and early detection of CKD and the Michigan Diabetic Knowledge Test. Methods We collected data from 2 Nablus primary healthcare centers using a questionnaire that contains three sections: sociodemographic section, questions related to DM, and CKD screening index, which is formed of three scales. We used the Michigan Diabetic Knowledge Test (MDKT) to assess the knowledge of diabetic patients. Results The study was carried out among 386 diabetic patients with a mean age of 57.62 ± 12.4 years (ranging from 28 to 90). The median (i...
Introduction: Depression or anxiety are associated with survival in heart failure (HF); however, ... more Introduction: Depression or anxiety are associated with survival in heart failure (HF); however, whether co-morbid symptoms of anxiety and depression are associated with survival in patients with HF is unknown. Hypothesis: Co-morbid symptoms of depression and anxiety are more strongly associated with all-cause mortality in patients with HF compared to those with anxiety or depression alone. Methods: A total of 1,260 HF patients participated and were followed for mortality outcomes for 12 months. The Patient Health Questionnaire (PHQ-9) and Brief Symptom Inventory-anxiety subscale (BSI) were used to measure symptoms of depression and anxiety. Cox regression analysis was used to determine whether co-morbid symptoms of depression and anxiety independently predicted all-cause mortality controlling for age,gender, ethnicity, and NYHA class. Depression and anxiety were treated first as continuous level variables, then as categorical variables using standard published cut points. Patients ...
Background: The impact of pre-existing chronic kidney disease (CKD) and acute kidney injury (AKI)... more Background: The impact of pre-existing chronic kidney disease (CKD) and acute kidney injury (AKI) on health outcomes in critically ill patients is unclear. Yet, CKD complicated by AKI in critically ill patients is common. Objectives: : To compare risk of death within one-month of admission in critically ill patients with and without pre-existing CKD who developed AKI. Methods: A multicenter retrospective comparative study using medical records review was conducted. Study participants consisted of 826 adult patients who received mechanical ventilation for at least 6 h in the critical care units from January 2012 to December 2017. Assessment of kidney function was established by serum creatinine. Severity and staging of AKI were defined using RIFLE criteria: Risk, Injury, Failure, Loss and End stage of renal disease. Chronic kidney disease was defined as eGFR > 60 ml/mg/1.73 m 2 on admission. Results: Pre-existing CKD was present in 55% of patients and 7% had AKI within 7 days of admission. The overall mortality rate among these patients was 87.3%. The mortality rate was highest in patients with CKD (70.1%) followed by that of patients without pre-existing CKD but with AKI (20.7%) and that of patients with pre-existing CKD (7.1%) and AKI. Risks associated with mortality were APACHE II score (1.03; 95% CI 1.02À1.05;(P<0.001) and AKI (1.68; 95% CI 1.12À2.5;P<0.01) in patients with pre-existing CKD. Only APA-CHI-II (1.03; 95% CI 1.0À1.1; p < 0.001) was predictive of death in patients without pre-existing CKD. Conclusion: : Pre-existing comorbid CKD increases risks of death among critically ill patients compared to patients without CKD and regardless of whether they develop AKI or not. Early identification of CKD and recognition of the risk for mortality among these patients may result in earlier intervention that could reduce mortality.
Commentary on: Jones DJ, Harvey K, Harris JP, et al. Understanding the impact of haemodialysis on... more Commentary on: Jones DJ, Harvey K, Harris JP, et al. Understanding the impact of haemodialysis on UK National Health Service patients' well-being: A qualitative investigation. J Clin Nurs . 2017; 27:193-204. ESRD is the advanced stage of chronic kidney disease and results when patients require renal replacement therapy. It is …
Purpose: The purpose of this study was to identify the relationship between spiritual well-being ... more Purpose: The purpose of this study was to identify the relationship between spiritual well-being (meaning/peace, and faith) and depression among Jordanian patients receiving hemodialysis. Methods: Cross-sectional descriptive correlation design was used to carry out on a nationally representative convenience sample of 158 patients receiving hemodialysis at five different hospitals in Jordan. Results: The mean total score of the depression was 17.8 of the 40. While the mean total score of the spiritual well-being was 36.9 of the 48. The Pearson's correlation coefficient test showed significant negative correlation between spiritual well-being and depression (r = −.64, p < .005). Conclusion: Healthcare providers should consider spiritual well-being in their assessment and interventions by helping the patients to establish meaning, peace, and faith to reduce patients' depression.
OBJECTIVE This study assessed the possible association of serum brain-derived neurotrophic factor... more OBJECTIVE This study assessed the possible association of serum brain-derived neurotrophic factor (BDNF) and interleukin-6 (IL-6) with depressive and anxiety symptoms in hemodialysis (HD) patients. METHOD An analytical cross-sectional study was conducted over 274 HD patients from March to October 2017. The Hospital Anxiety and Depression Scale (HADS) was utilized to evaluate depressive (HADS-D) and anxiety (HADS-A) symptoms. The HADS-D/A is a self-report instrument that has a maximum score of 21. Serum BDNF and IL-6 were measured using enzyme-linked immunosorbant assay (ELISA). RESULTS Serum IL-6 was significantly higher in patients with depressive symptoms compared to normal (20.47 ± 4.27 pg/mL for HADS-D ≥11 versus 9.26 ± 1.59 pg/mL for HADS-D <7, p = 0.014). Multivariable regression analysis revealed that IL-6, education level, hypertension, and dialysis duration were significant predictors of HADS-D. Also, gender, education level, hypertension, and the number of dialysis sessions/week were significant predictors of HADS-A. Significant positive correlation was shown between HADS-D and IL-6 (r = 0.1729, p = 0.004). CONCLUSION Collectively, HD patients with depressive symptoms showed higher levels of IL-6, supporting previous findings that the circulating inflammatory mediator IL-6 can be used as a biomarker for prediction of depressive symptoms in HD patients. Further longitudinal or interventional studies are needed to further validate this association.
Progress in Neuro-Psychopharmacology and Biological Psychiatry, 2019
Psychological symptoms are prevalent in hemodialysis (HD) patients. Previous investigations showe... more Psychological symptoms are prevalent in hemodialysis (HD) patients. Previous investigations showed that brain-derived neurotrophic factor (BDNF) and interleukin-6 (IL-6) as well as the interaction with neuropeptide S receptor 1 (NPSR1) are linked to the development of psychological distress. This study examined the association of polymorphisms of genes encoding these proteins with depression and anxiety in a representative group of Jordanian HD patients. Methods: A total of 302 HD patients were involved in the study and categorized into three groups based on the Hospital Anxiety and Depression Scale, HADS-D or HADS-A scores as follows: normal (<7), mild (8-10) and moderate-severe (11 to 21). Single nucleotide polymorphism (SNP) of NPSR1 Asn107Ile (rs324981), IL-6 G174C (rs1800795), and BDNF Val66Met (rs6265) was genotyped using blood samples. Results: The frequency of Ile-allele of NPSR1 Asn107Ile was significantly higher in patients with moderate-severe HADS-A scores versus normal (53% vs. 40.8%, p=0.035). Using ordinal regression analysis, Asn-allele of NPSR1 polymorphism was nominally significantly associated with a lower risk of anxiety (OR=0.57, CI: 0.33-0.97, p=0.038) after adjusting for other covariates. A marginally significant difference in genotype distribution of IL-6 G174C was observed among patients according to HADS-D scores (p=0.05). Furthermore, carriers of IL-6 174 CC genotype showed lower median IL-6 serum concentration versus carriers of GG genotype (5.2 vs. 1.35 pg/mL, p<0.05). Conclusions: The results support the genetic role of NPSR1 in the pathogenesis of anxiety and suggest that carriers of NPSR1 Ile-allele are at increased risk of anxiety in HD patients. Neither BDNF Val66Met nor IL-6 G174C were linked to psychological symptoms. Future studies among other ethnicities are necessary to verify the observations.
Background: Surviving a warzone inflicts harmful consequences on the physical health and the psyc... more Background: Surviving a warzone inflicts harmful consequences on the physical health and the psychosocial wellbeing of children. This study aimed at exploring the physical and psychosocial perceived state of health of displaced Syrian refugee children in Jordan. Methods: A cross-sectional explorative design was applied. Structured questionnaires were used to collect data through face-to-face interviews with 250 Syrian refugee children. Descriptive and inferential statistics were used. Results: Children had fair levels of physical health; their health concerns were minor. Psychosocially, 25% (n = 63) suffered from loneliness and 24% (n = 59) reported feeling depressed. The majority of children (>60%) had low rates of somatic pain. Age had a negative correlation with hyperactivity (r = À.14, p = .034); gender differences were found in anger expression and anger trait (p < .05). Conclusions: The results in this study highlight a number of physical and psychosocial health concerns among refugee children. The health needs of displaced Syrian children need to be addressed using comprehensive assessment and care. Our findings documented the physical and psychosocial health needs of the displaced Syrian children in Jordan and addressed areas of focus to guide health promotion interventions and community health efforts for them. Key Practitioner Message • The wellbeing of the refugee children is a genuine community health concern. • The vast mental, emotional, behavioral, and social health concerns of Syrian refugee children need to be recognized and supported by humanitarian and organizational services. • The health care services provided require comprehensive and multidimensional approaches to address the psychosocial as well as the physical health needs of the Syrian refugee children in camps and host communities. • Access to comprehensive psychological support is essential as early as possible after displacement to support smooth atraumatic transition of the refugee children into the host community. • Skilled, well trained, and specialized health care providers are crucial to provide quality comprehensive health care services to refugee children.
Background: Jordan has no relevant database or registry by which chronic kidney disease (CKD) wou... more Background: Jordan has no relevant database or registry by which chronic kidney disease (CKD) would be early identified. The purpose of the present study is to uncover the prevalence of CKD in a national sample of Jordanian patients at high risk and examine the association of CKD with demographic and clinical factors. Methods: This is a cross-sectional, correlational study that involved 540 outpatients at high risk for CKD. Demographic and clinical data were obtained in the period from September 2013 to March 2014. Prevalence of CKD was defined based on the National Kidney Foundation Kidney Disease Outcomes Quality Initiative Classification of CKD using estimated glomerular filtration rate. Associations of CKD and demographic and clinical factors were examined using bivariate analysis. Results: The majority of the sample were females (64%), their mean age (AESD) was 55.0 AE 12.5 years, their mean eGFR (AESD) was 116.0 AE 47.5. One third of patients had eGFR of 23.5%, 5.4%, 0.7% and 0.7% which corresponds with mild, moderate, severe and very severe reduction in eGFR, respectively. Ageing, being male, unemployment, packs/years of smoking, comorbidities [hypertension (HTN), diabetes mellitus (DM) and cardiovascular disease] and low high density lipoprotein (HDL) correlated positively with development of CKD. Conclusion: This study demonstrates a high rate of under-diagnosed CKD among Jordanians. Several demographic and clinical factors are linked with the development of CKD. Policymakers and healthcare providers need to establish an evidence-based practice project to prevent and screen for CKD in Jordan.
International Nursing Review En Espanol Revista Oficial Del Consejo Internacional De Enfermeras, 2014
Objetivo: Describir el conocimiento, las actitudes y las practicas de pacientes jordanos con enfe... more Objetivo: Describir el conocimiento, las actitudes y las practicas de pacientes jordanos con enfermedades cro~ nicas hacia la prevencion y deteccion temprana de la insuficiencia renal cronica. Antecedentes: Los pacientes con enfermedades cronicas como hipertension y diabetes necesitan adoptar actitudes y practicas saludables y lograr conocimientos sobre la prevencion y deteccion temprana de la insuficiencia renal para disminuir la prevalencia de complicaciones y costes relacionados con la dialisis. Metodos: Un total de 740 pacientes fueron seleccionados en clinicas de pacientes ambulatorios en Jordania. Los conocimientos, las actitudes y las practicas sobre la prevencion y deteccion temprana de la insuficiencia renal se midieron utilizando el Indice de Deteccion de Insuficiencia Renal Cronica, que fue desarrollado por el in vest igador y probado para validez y fiabilidad. Resultados: Los resultados revelaron que la mayoria de los participantes tienen conocimientos sobre la insuficiencia renal; sin embargo, la mitad de ellos tenian informacion incorrecta relacionada con los signos y sintomas de insuficiencia renal cronica. La mayoria de participantes no eran conscientes de la importancia de descubrir los problemas de salud en las etapas tempranas. Conclusion e implicaciones: Es necesario mejorar la comprension de la poblacion sobre la insuficiencia renal cronica para avanzar en su concienciacion y practicas para tomar decisiones oportunas relacionadas con la promocion de la salud y una mejor calidad de vida. Implicaciones para el desarrollo de normativas: Las enfermeras deben participar en el desarrollo de protocolos para los programas de deteccion e intervencion, tener en cuenta las cuestiones culturales y la situacion economica de las personas en riesgo de enfermedad renal. Los gobiernos deberian adoptar una politica de salud publica para la insuficiencia renal cronica que apoye los programas de deteccion y los programas para mejorar la conciencia publica para la prevencion de la insuficiencia renal.
Regular physical activity has been associated with reduced cardiovascular disease (CVD) risk fact... more Regular physical activity has been associated with reduced cardiovascular disease (CVD) risk factors; however, a decrease in the amount of time spent during the remainder of the day in sedentary behavior may be equally important. The aim of this study was to examine the effects of a decrease in sedentary behavior on CVD risk factors among 205 individuals living in rural Appalachia. All participants received a comprehensive CVD risk reduction lifestyle intervention and measurement of major CVD risk factors and physical activity levels. Participants were divided into: 1) Adopters: those who decreased their sedentary behavior by 30 min or more per day post-intervention and 2) Non-adopters: those who did not. Repeated measures analysis of variance showed a significant group by time interaction showing that Adopters had a greater reduction in body weight and BMI than Non-adopters. These findings demonstrate that decreasing sedentary behavior is important for achieving optimal body weight.
Qualitative investigators have suggested that symptom incongruence, or a mismatch between symptom... more Qualitative investigators have suggested that symptom incongruence, or a mismatch between symptoms that patients expect and those they experience in acute myocardial infarction (AMI), increases the time to hospitalization by affecting emotional, cognitive, and behavioral factors. No quantitative studies have been conducted that verify these relationships. We aimed to (a) examine the relationships among symptom incongruence, prehospital delay, anxiety level at onset of symptoms, perceived seriousness and importance of symptoms, source to which symptoms were attributed, and patients' first response at symptom onset and (b) test the independent association of symptom incongruence to prehospital delay. Jordanian patients with AMI (n = 299) were interviewed using validated questionnaires, and medical records were reviewed to collect information on patients' prehospital delay time, symptom incongruence, and response to AMI symptoms. Patients had low mean (7.5 ± 3.6) symptom incong...
Purpose: To explore Jordanian chronic illnesses patients' perceived exercise self-efficacy, benef... more Purpose: To explore Jordanian chronic illnesses patients' perceived exercise self-efficacy, benefits and barriers, and commitment to exercise planning, and to assess the relationship between those variables. Design: Descriptive cross-sectional design. Methods: Data were collected from a convenience sample of 402 outpatient Jordanians with chronic illnesses, using Exercise Self-Efficacy Scale, Exercise Benefits and Barriers Scale, and Commitment to a Plan for Exercise Scale. Findings: The average BMI was 28.3, and exercise period 3.2 hours/ week. Participants reported moderate perceived self-efficacy (M= 47.5%, SD= 11.7), commitment to exercise planning (M=2.0/3, SD=0.3), exercise barriers (M=2.4/ 4, SD=0.3), and benefits (M=2.3/4, SD=0.3). Commitment to exercise planning had a significant correlation with barriers (r=0.11) and benefits (r=0.10). Selfefficacy was not found to correlate with other variables. Conclusions: Even though participants reported higher perceived self-efficacy and commitment to exercise plan than that reported in literature, they were found to be overweight and inactive, which indicates the importance of such study. Exercise education programs are needed taking into considerations patients' individual differences. However, the broad grouping of diseases may not produce a homogenous sample, for which disease categories are recommended in future studies. Clinical Relevance: Patients with chronic illness need more encouragement to engage themselves in exercise practices. Exercise educational program for patients with chronic illnesses should consider patients' reported exercise benefits and barriers.
Purpose: To investigate Jordanian end-stage renal disease (ESRD)patients' perceived exercise bene... more Purpose: To investigate Jordanian end-stage renal disease (ESRD)patients' perceived exercise benefits and barriers, and their correlation with patients' demographic variables and dialysis measures. Methods: A descriptive correlational study was conducted using cross-sectional survey, using a convenience sample of 190 ESRD dialyzed patients who were recruited from eight hospitals in Jordan. Findings: Participants significantly perceived exercise benefits (M= 2.88/4, SDAE .67) higher than barriers (M= 2.66, SDAE .62). The most frequent perceived exercise benefits were preventing muscular atrophy and improving mood, whereas tiredness and lower-extremity fatigue were the most frequent exercise barriers. Finally, acceptable values of Cronbach's Alpha were revealed for perceived exercise subscale, barriers subscale, and total scale (a= .88, .81, and .70, respectively). Conclusion: Participants focused more on exercise benefits than barriers, and on direct exercise benefits and barriers than the indirect. Clinical Relevance: The results of this study have important implications for the efforts that aim at improving ESRD patients' exercise behaviors.
Background and objective: Breast cancer is the most common malignancy among women worldwide, diag... more Background and objective: Breast cancer is the most common malignancy among women worldwide, diagnosis and treatment and the months following primary therapy associated with different psychological symptoms that affect quality of life (QoL) in most women with breast cancer. The aim of this study was to identify the relationship between depression and quality of life QoL among Saudi women with breast cancer.Methods: Design: This is a descriptive, cross-sectional study. Methods: A convenience sample of 370 women with breast cancer was recruited from the out-clinic in King Faisal Specialist Hospital \& Research Center (KFSH&RC). Data were collected using self-report tools derived from the Patient-Reported Outcomes Measurement Information System (PROMIS) Emotional Distress-Depression-Short Form; the EORTC quality of life questionnaire (QLQ) (EORTC QLQ-C30, v.3.0 and EORTC QLQ-BR23); and from the Demographic and Clinical Data Sheet.Results: The correlation between depression and global h...
The current study aimed to examine the effect of depressive and anxiety symptoms on physical and ... more The current study aimed to examine the effect of depressive and anxiety symptoms on physical and psychological quality of life (QOL) in end-stage renal disease patient-family caregiver dyads using the Actor-Partner Interdependence Model. This was a descriptive cross-sectional study. Dyads' (N = 120) symptoms of anxiety and depression and QOL were assessed via the Hospital Anxiety and Depression Scale and the World Health Organization (WHO)QOL-BREF, respectively. The depression scores were higher (worse) in patients than in caregivers (8.74 AE 5.23 vs. 6.9 AE 3.9, t[df 119] = 3.339, p = .001). Patients had lower (worse) scores on the physical domain of QOL than the caregivers (47.37 AE 22.9 vs. 64.1 AE 17.49, t[df 119] = −7.165, p < .001). Anxiety and depressive symptoms exhibited actor effects on the physical and psychological QOL of the dyad. Only depressive symptoms in caregivers exhibited a partner effect on the psychological domain of QOL in patients (β = −.745, p < .05). In conclusion, anxiety and depressive symptoms in both patients and caretakers are equally crucial in end-stage renal disease management.
Purpose: The review aimed to find the best evidence on the relationship between health literacy, ... more Purpose: The review aimed to find the best evidence on the relationship between health literacy, self-care behavior and perceived quality of life (QoL) among patients with acute coronary syndrome (ACS). Methods: Searching engines included Cumulative Index to Nursing Allied Health Literature (CINAHL), Pro Quest, MEDLINE, Google Scholar, SAGE Journals, Wiley on Line Library, and Science Direct electronic databases from 2010 to 2018. Fifteen research articles assessed the main variables and their associations with demographic and clinical variables. Results: Different methodologies and samples were analyzed: analytic descriptive, systematic review, a randomized control trial, retrospective cohort, a prospective Cohort, cross-sectional, and correlational designs. The fifteen studies showed that the patients with ACS have inadequate health literacy. Patients' ability to understand basic and complex information or to accurately assess health risks was impaired and may hinder patients' engagement in self-care. Low HL in patients having ACS is consistently associated with poor QoL. Physical domain of QoL remained the significant outcome of both self-care behavior and health literacy after adjusting for demographics and clinical variables in patients with ACS. Conclusion: The literature pointed to the importance of considering health literacy and self-care behaviors as predictors of quality of life among patients with ACS. However, there has been no previous evidence on the best process of the association between these three variables.
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