Vitamin B12 Deficiency Among the Healthy Jordanian Adult Population: Diagnostic Levels, Symptomology and Risk Factors.

BACKGROUND: Compared to the data available for developed countries, there is a marked scarcity of information on the levels and symptomology of vitamin B12 deficiency in developing countries, particularly in the Middle Eastern region. OBJECTIVE: To explore (a) the risk factors associated with a deficiency of vitamin B12, and (b) the baseline (cut-off) serum level of vitamin B12 for a clinically-symptomatic deficiency in the Jordanian adult population. METHODS: A total of 485 subjects were included in this study. Blood samples were drawn for biochemical analysis and data regarding socio-demographics, general health, anthropometric measures, and past medical, surgical, and medication history were collected. To explore the cut-off point, we compared all parameters included in a standard complete blood count as well as the main symptoms reported to be associated with B12 deficiency between groups of different B12 cut-off values, consisting of those above and below 200, 175, 150 and 125 pg/ml. RESULTS: Low dairy intake habits, age, recurrent headaches, heartburn, and peptic ulcer disease were found to be significantly associated with lower vitamin B12 levels. Surprisingly, daily smoking was associated with significantly higher B12 levels. The results revealed that none of the included potential indicators of B12 deficiency could be considered an indicative feature of deficiency. There were no significant differences neither in the symptoms nor in the CBC parameters between any of the tested study groups. CONCLUSION: Low dairy intake, older ages, recurrent headaches, heartburn, and peptic ulcer disease all could be considered as risk factors of having low vitamin B12 levels within the Jordanians. Also, they tend to have lower levels of vitamin B12 levels, in comparison to countries in the West, without necessarily having deficiency symptoms. The cut-off value to diagnose functional B12 deficiency could be less than 125 pg/ml for the Jordanians. More local studies are needed to establish an accurate vitamin B12 cut-off value for the population in Jordan.

Monitoring for the metabolic side effects of second-generation antipsychotic medications: Psychiatrists' views and practices.

PURPOSE: The aims of this study were to explore (1) the knowledge, attitudes, practices, and adherence of psychiatrists in Jordan regarding published guidelines for metabolic monitoring of patients taking second-generation antipsychotics (SGAs), and (2) their perceived barriers to metabolic screening. METHODS: The study utilized a cross-sectional survey. Data were collected from 91 psychiatrists using a self-administered questionnaire. FINDINGS: Almost 74% of psychiatrists reported they were aware of metabolic screening guidelines for patients taking SGA. However, the results of their assessment practices revealed a lack of adherence to these guidelines. Reported barriers to metabolic screening were the financial burden on the family and lack of family and patient compliance with recommendations of monitoring. PRACTICE IMPLICATIONS: Metabolic side effects of SGAs are important in Arab countries, where baseline levels of obesity and metabolic syndrome are already high in the general population. By virtue of their close proximity to patients, nurses are ideally placed to monitor how patients perceive SGAs and to provide information, advice, and counseling support.

A pilot study of depression, stigma, and attitudes towards seeking professional psychological help among Arab adolescents.

The Arab region has the largest proportion of young people in the world and many of the factors that contribute to the onset of depression. Yet, very little is known about the current situation of depression and its associated stigma in this region. The purpose of this pilot study was to obtain preliminary data examining clinically significant depressive symptoms, depression stigma, and attitudes towards seeking professional help for depression among a sample of Arab adolescents from Jordan. Cross-sectional data were collected from 88 adolescents attending public schools in Jordan using self-report questionnaires that were available in, or translated into, Arabic. Among the 88 adolescents, 22% reported scores suggesting mild depression and 19% reported scores suggesting moderate depression, while 24% reported scores suggesting severe depression. The most frequently reported depressive symptoms were changes in sleep patterns (76%), changes in appetite (63%), agitation (62%), and crying (61%). The majority (73%) had moderate depression stigma, and 43% had negative attitudes towards seeking professional help. Yet, 67% believed they would find relief in psychotherapy if they ever had a serious emotional crisis. Findings suggest that the prevalence of depressive symptoms may be high among Jordanian adolescents. Further, many of these adolescents may experience depression-related stigma that affects their attitudes and willingness to seek professional help. To determine the true scope of these issues, including the prevalence of depression among Jordanian adolescents, future research should obtain data from a nationally representative sample.

Adolescent Depression in the Arab Region: A Systematic Literature Review.

Adolescent depression is a primary cause of global disability and burden with considerable variability across countries in its prevalence, diagnosis, management, and prognosis. No systematic reviews have been published on adolescent depression in Arab countries despite the unique sociocultural background that can play a major role in shaping Arab depressed adolescents' prognosis and response to treatment. The purpose of this study was to provide such a review with the goal of identifying the necessary foundations for culturally competent mental health care practices to address the unique needs of Arab adolescents and their families. We systematically reviewed PubMed, CINAHL, PsycINFO, and available Arabic databases. We adhered to the PRISMA statement to guide the process of identification, selection, and appraisal of the reviewed articles. No restrictions were applied on publication date. The search was completed in December 2015. A total of 199 unique articles met criteria for screening at the abstract level; 47 articles were selected for review in full text; and 27 articles were included in the final analysis. Four emerging themes were identified: (1) few robust prevalence estimates of adolescent depression are available in Arab countries; (2) depression varies based on the individual characteristics of Arab adolescents; (3) context influences Arab adolescents' risk of experiencing depression; and (4) the stigma of depression negatively impacts help-seeking process among Arab adolescents. This review highlights the need for more community-based detection efforts that employ developmentally and culturally appropriate measurement instruments for adolescent depression. Furthermore, findings suggest the need for culturally competent care that integrates indigenous health practices into modern mental health systems. Nurses, who form the greatest proportion of health personnel in all Arab countries, are uniquely situated to help Arab adolescents experiencing depression restore, maintain, and/or promote their mental health and wellbeing.

For fathers raising children with autism, do coping strategies mediate or moderate the relationship between parenting stress and quality of life?

In response to the dramatic change in the perception of fatherhood and the significant expansion in fatherhood research, this study came to fill the gap in literature and examine the possible mediation and moderation effects of coping in the relationship between fathers' of children with autism parenting stress and quality of life (QoL). Mediation and moderation effects were examined using multiple programs and software which included hierarchical regression, structural equation modeling and special Macros added to the analysis programs to confirm the findings. None of the investigated coping strategies could mediate or moderate the stress-QoL relationship among the 101 participating fathers. This study provides interesting information on how the stress-coping-QoL relationship among fathers of children with autism can be affected by the nature of their stress provoking situation, their individual characteristics, the environment and its demands and resources, and the way fathers perceive and apply their coping responses.

Coping strategies as mediators and moderators between stress and quality of life among parents of children with autistic disorder.

The purpose of this cross-sectional study was to examine coping strategies as mediators and moderators between stress and quality of life (QoL) among parents of children with autistic disorder. The convenience sample of the study consisted of 184 parents of children with autistic disorder. Advanced statistical methods for analyses of mediator and moderator effects of coping strategies were used. The results revealed that 'accepting responsibility' was the only mediator strategy in the relationship between stress and QoL. The results also revealed that only 'seeking social support' and 'escape avoidance' were moderator strategies in the relationship between stress and QoL. This study is perhaps the first to investigate the mediating and moderating effects of coping on QoL of parents of children with autistic disorder. Recommendations for practice and future research are presented.

Validation of the World Health Organization's Quality of Life Questionnaire with parents of children with autistic disorder.

The World Health Organization's Quality of Life Questionnaire-BREF (WHOQOL-BREF) has been used in many studies that target parents of children with Autistic Disorder. However, the measure has yet to be validated and adapted to this sample group whose daily experiences are considered substantially different from those of parents of children with typical development and parents of children with other disabilities. Therefore, this study was designed to examine the psychometric properties and the theoretical structure of the WHOQOL-BREF with a sample of 184 parents of children with Autistic Disorder. The factor structure for the WHOQOL-BREF was examined using exploratory and confirmatory factor analyses. Our analyses provided no evidence of a better model than the original 4-domain model. Nevertheless, some items in the measure were re-distributed to different domains based on theoretical meanings and/or clean loading criteria. The new model structure gained the measure's required validity with parents of children with Autistic Disorder.

Quality of life among parents of children with autistic disorder: a sample from the Arab world.

BACKGROUND: A growing body of research has sought to examine issues associated with the Quality of Life (QoL) of parents of children with Autistic Disorder. However, no studies have examined the QoL of Arab parents whose parenting experience is expected to be substantially different from that of their western counterparts. Therefore, the purposes of this study were: (1) to examine differences in the QoL between fathers and mothers of children with Autistic Disorder in a sample from an Arab country, and (2) to examine the psychosocial correlates of the QoL of Arab parents of children with Autistic Disorder. METHODS: Self-administered questionnaires on parents' QoL, stress, coping strategies, and demographic characteristics were completed by 184 parents of children with Autistic Disorder. The participants were recruited using the convenience sampling design. RESULTS: Fathers and mothers of children with Autistic Disorder showed no significant differences in their physical, psychological, social, and environmental health. Further, both parents showed almost similar bivariate correlations between the reported QoL levels and their parenting stress, coping strategies, and demographic characteristics. CONCLUSION: This is the first study to examine the QoL of parents of children with Autistic Disorder in the Arab world and, in doing so, it highlighted the distinct lack of research in this area. The QoL of Arab parents of children with Autistic Disorder crosses lines with their stress levels, coping strategies, demographic characteristics, and to some extent their cultural context.