Profile of cancer family clustering in Jordan.

This paper explores cancer family clustering in a random sample of patients registered in the Jordan National Cancer Registry for the year 1999, the most recent year that complete data were available. A special instrument was designed and data collected through personal interviews. Of the final sample of 707 cancer patients, 23% had a positive family history of cancer, 59% of which was first-degree clustering. For every proband there were 1.39 contacts. Half of them were first-degree relatives of the proband and 17% had cancer at the same site as the proband. Family clustering of cancer in Jordan appears to be of public health significance, and we recommend immediate and thorough followup of family members of cancer cases.

Profile of cancer family clustering in Jordan

This paper explores cancer family clustering in a random sample of patients registered in the Jordan National Cancer Registry for the year 1999, the most recent year that complete data were available. A special instrument was designed and data collected through personal interviews. Of the final sample of 707 cancer patients, 23% had a positive family history of cancer, 59% of which was firstdegree clustering. For every proband there were 1.39 contacts. Half of them were first-degree relatives of the proband and 17% had cancer at the same site as the proband. Family clustering of cancer in Jordan appears to be of public health significance, and we recommend immediate and thorough followup of family members of cancer cases

Multiple sclerosis conference synopsis and discussion: cellular therapy for treatment of autoimmune diseases (October 2005).

At a conference held in October 2005, participants presented studies on high dose immunosuppression with hematopoietic cell transplant (HCT) for multiple sclerosis (MS), including neuroimmunological and magnetic resonance imaging (MRI) mechanistic approaches, clinical registry reports, and ongoing or newly-designed protocols. A discussion panel considered questions on how to define success, timing of controlled clinical trials, difficulty in patient recruitment, and future direction of high dose therapy.

Identification of Leishmania strains from Jordan.

The enzymatic profiles of 22 Jordanian Leishmania isolates obtained from humans, Psammomys obesus and Phlebotomus papatasi were determined using starch-gel electrophoresis and a 15-enzyme system. Thirteen of the isolates were typed as L. major and the other nine, all from Mediterranean or sub-Mediterranean regions, as L. tropica. The two zymodemes of L. major encountered, MON-26 and MON-103, differed in terms of purine nucleoside phosphorylase 2. The MON-26 isolates came from the Jordanian plateau whereas those of MON-103 were only collected from the Jordan valley. The four zymodemes of L. tropica observed (MON-7, MON-137, MON-200 and MON-265) were identical for only two of the 15 enzymes studied (i.e. isocitrate dehydrogenase and glucose phosphate isomerase), confirming the high level of enzymatic polymorphism of L. tropica. So far, MON-200 and MON-265 have only been found in Jordan.

Performance of health providers in primary health care services in Jordan.

The study analysed time utilization by a sample of 111 physicians, nurses and midwives in 62 primary health care facilities in Jordan. The providers' activity over each shift was coded at 3-minute intervals using an activity sampling technique and patient-provider contact times were recorded. Overall, health providers spent the nearly half their time (48.7%) as down time' (waiting, breaks and non-work related activities), with 29.1% as clinical activities and 22.1% as non-clinical work-related activities. Physicians had higher clinical and down times than nurses and midwives; waiting for patients accounted for half the down time. The mean physician-patient contact time was 3.08 minutes. An appointment system is recommended to reduce down times for health providers and increase consultation times.

Reducing health care costs by rationalizing staffing in primary care settings.

Jordan spends around 9% of its GDP on health care services, a high figure compared with similar developing countries. This study assessed staffing patterns in relation to Ministry of Health expenditures in a nationally representative sample of 97 primary care facilities. The economic costs of primary care facilities amounted to Jordanian dinar (JD) 42.3 million. Personnel costs consumed 53.8% of recurrent costs and in monetary terms the amount of down time (time not being used effectively) amounted to JD 9.7 million (about US$ 13.7 million). The Ministry should consider changing the functioning of its primary care facilities to obtain a more cost-effective use of staff time.

Reducing health care costs by rationalizing staffing in primary care settings

Jordan spends around 9% of its GDP on health care services, a high figure compared with similar developing countries. This study assessed staffing patterns in relation to Ministry of Health expenditures in a nationally representative sample of 97 primary care facilities. The economic costs of primary care facilities amounted to Jordanian dinar [JD] 42.3 million. Personnel costs consumed 53.8% of recurrent costs and in monetary terms the amount of down time [time not being used effectively] amounted to JD 9.7 million [about US$ 13.7 million]. The Ministry should consider changing the functioning of its primary care facilities to obtain a more cost-effective use of staff time

Performance of health providers in primary health care services in Jordan

The study analysed time utilization by a sample of 111 physicians, nurses and midwives in 62 primary health care facilities in Jordan. The providers' activity over each shift was coded at 3-minute intervals using an activity sampling technique and patient-provider contact times were recorded. Overall, health providers spent the nearly half their time [48.7%] as down time' [waiting, breaks and non-work related activities], with 29.1% as clinical activities and 22.1% as non-clinical work-related activities. Physicians had higher clinical and down times than nurses and midwives; waiting for patients accounted for half the down time. The mean physician-patient contact time was 3.08 minutes. An appointment system is recommended to reduce down times for health providers and increase consultation times

Incidence of pulmonary edema after tracheotomy for obstructive sleep apnea.

OBJECTIVE: The phenomenon of postobstructive pulmonary edema (POPE) has been associated with the relief of upper airway obstruction, which itself is fundamental to the pathophysiology of obstructive sleep apnea (OSA). A review of patients with OSA undergoing tracheotomy was performed to characterize this process. STUDY DESIGN: Retrospective chart review of study patients with OSA undergoing tracheotomy and of control patients without OSA undergoing tracheotomy for unrelated problems. Chest radiographs were reviewed in a double-blind fashion to score posttracheotomy changes in pulmonary status. SETTING: Academic tertiary referral center. RESULTS: Thirty (67%) of 45 OSA patients treated by tracheotomy had evidence of POPE, whereas only 5 (20%) of 25 control group patients had increased pulmonary edema. The remaining 15 (33%) of 45 OSA patients and 20 (80%) of 25 control patients had either no change or an improved pulmonary status. Those with OSA that developed POPE were mostly graded as having mild pulmonary edema (22/30, 73%). Far fewer were graded as having moderate pulmonary edema (6/30, 20%), and fewer still with severe pulmonary edema (2/30, 7%). Two (7%) of 45 patients with severe POPE died of complications related to cor pulmonale in the postoperative period. CONCLUSION: Results support maintaining a high index of suspicion for the development of postobstructive pulmonary edema in patients treated for OSA. Treatment options, such as positive pressure ventilation and diuresis, and an increased awareness of this condition may help reduce the morbidity and mortality associated with treatment of this disease.

Incidence of iron-deficiency anaemia in infants in a prospective study in Jordan.

A high prevalence of iron-deficiency anaemia has been reported in Jordanian infants. A prospective study of infants in downtown Amman examined the relationship between anaemia in pregnancy and iron deficiency in infancy. The iron status of infants born to 107 anaemic (Hb < 11 g/dl) and 125 non-anaemic mothers was reviewed at 3, 6, 9 and 12 months. Indicators to define iron-deficiency anaemia were Hb < 11 g/dl and either plasma ferritin < 12 microg/l or zinc protoporphyrin (ZPP) > 35 microg/dl whole blood. Haemoglobin electrophoresis excluded haemoglobinopathy. There was 72% iron-deficiency anaemia throughout the year, significantly higher in infants born to anaemic mothers (81%; n = 91) compared with controls (65%; n = 112). At 12 months, 72% of the infants tested (n = 195) were anaemic. While 57% were identified as iron-deficient by research criteria of either ferritin or ZPP, only 37% were identified by ferritin alone, 40% by ZPP alone and 29% if both ferritin and ZPP were required to meet criteria. Most infant anaemia was identified as due to iron deficiency, supporting contextual setting as assisting diagnosis: infants in developing countries are recognised as vulnerable to iron deficiency. Using multiple criteria, more cases were identified when either ferritin or ZPP were abnormal than when one alone, or both parameters were required to meet research criteria.

Iron status, serum folate and B(12) values in pregnancy and postpartum: report from a study in Jordan.

BACKGROUND: A high prevalence of anemia has been reported in Jordan affecting women of childbearing age and infants/preschool children. This paper considers maternal iron, folate and B(12) status, with possible implications for both maternal and infant health. PATIENTS AND METHODS: A case-control study of infants born to anemic (Hb <11 g/dL) (n=107) and non-anemic mothers (n=125) from birth to one year, was conducted in a lower middle-class urban setting in Amman, Jordan. Maternal hematology included full blood count (FBC), plasma ferritin, transferrin saturation, serum folate and B(12) at term, and FBC and ferritin at 6 months postpartum. Serum B(12) was reassessed at 6 and 12 months postpartum if antenatal values were low. Infant FBC and ferritin were assessed in cord blood and at 3, 6, 9 and 12 months, and zinc protoporphyrin (ZPP) from 6 months. RESULTS: Anemic mothers (mean [SD] Hb 9.9 [0.7] g/dL) had significantly lower antenatal values for Hb, MCV, MCH, transferrin saturation, plasma ferritin and serum folate than non-anemic mothers (mean Hb 12.2 [0.9] g/dL), which persisted at 6 months postpartum. Antenatal B(12) values were low (<200 pg/mL) in 67% of samples (26% <100 pg/mL), evenly distributed between the groups, and, therefore, not related to maternal anemia. Low values persisted in 27% (n=127) and in 61% (n=31), respectively, at 6 and 12 months postpartum. Iron deficiency anemia (Hb <11 g/dL and either ferritin <12 mcg/L or ZPP >35 mcg/dL) affected 72% of infants, with significantly higher incidence in those born to anemic mothers. Ambiguous hematology in 11% of infants may have reflected other nutritional deficiencies, including vitamin B(12), where mothers had depleted values. CONCLUSION: Iron, folate and B(12) status should be monitored during pregnancy/lactation in developing countries, where nutritional deprivation is more prevalent and women of childbearing age often have a high fertility rate and inadequate inter-pregnancy interval to replenish body stores. Infant health may also be at risk through a compromised endowment of these micronutrients at birth.

Consanguinity, fertility, reproductive wastage, infant mortality and congenital malformations in Jordan.

OBJECTIVES: Consanguinity is a wide spread practice in Jordan. The objective of this study is to explore the health effects of consanguinity, in particular fertility, reproductive wastage, infant mortality and congenital malformations. METHODS: A stratified 2 stage cluster sample of 1867 married couples, representative of all population groups and all geographic locations of Jordan were randomly selected. A questionnaire was specially designed to explore each of the objectives set for the study and was field tested. A group of field workers were thoroughly trained on the implementation of this instrument. All 1867 couples were interviewed by these field workers and completed questionnaires were reviewed before data entry. Data analysis was carried out using SPSSX statistical package. Significance tests were performed wherever appropriate. RESULTS: The study showed that fertility, as measured by the number of pregnancies, taking into consideration marriage duration, was not affected by consanguinity. Twin pregnancies and abortions did not show any significant difference between consanguineous and non-consanguineous marriages. Consanguineous marriages showed significantly higher rates of still births and infant mortality in general. Within the consanguineous group, female infant mortality rates were significantly higher than those of males. Congenital malformations as reported by mothers of consanguineous marriages were significantly higher than those reported by mothers of non-consanguineous marriages. CONCLUSION: This study showed that consanguinity has a detrimental effect on many aspects of reproductive health.

Mortality and causes of death in Jordan 1995-96: assessment by verbal autopsy.

Mortality indicators and causes of death in Jordan were assessed by verbal autopsy. A random sample of 100 clusters of ca. 300 households each were monitored for one year by notification assistants selected from the study area itself. Registered deaths were reported to research assistants who visited the family to complete the verbal autopsy form, which was structured and contained about 100 questions. Causes of death were determined by two physicians according to preset algorithms. A total of 965 deaths were reported among 198,989 persons, giving a crude death rate of 5 per 1000 population per year. The three leading causes of death were diseases of the circulatory system, malignancies and accidents. In the absence of a health information system, verbal autopsy as implemented in Jordan can serve as a reliable substitute.

PIP: This paper presents an assessment of mortality indicators and causes of death in Jordan during 1995-96 using verbal autopsy. A random sample of 200,000 subjects were divided into 100 clusters, with each cluster representing 1300 households. Two physicians determined the causes of death. Registered deaths were reported by the completion of a verbal autopsy form, which was structured and contained some 100 questions. Among 198,989 persons, 965 deaths were reported, indicating a crude death rate of 5 per 1000 population per year. The three leading causes of death were diseases of the circulatory system, malignancies, and accidents.

Anaemia during pregnancy as a risk factor for iron-deficiency anaemia in infancy: a case-control study in Jordan.

BACKGROUND: A high prevalence of 50-65% iron-deficiency anaemia in mothers and infants in Jordan was reported by the United Nations Relief and Works Agency (UNRWA) in 1990. Iron-deficiency in infancy has been shown to delay cognitive and psychomotor development with long-term consequences. While socioeconomic deprivation and inadequate nutrition are known underlying factors, it is unclear whether iron endowment at birth is compromised when mothers are anaemic, further jeopardizing iron status during infancy. A prospective case-control study of infants from birth to one year was conducted in a lower middle-class urban setting in Amman, Jordan. The study objective was to examine the relationship between maternal anaemia and iron-deficiency anaemia during infancy. METHOD: A sample of 107 anaemic (Hb < 11 g/dl) and 125 non-anaemic mothers was selected at 37 weeks' gestation and matched for age and parity, and infant data at birth obtained. The infants were reviewed at 3, 6, 9 and 12 months, to assess growth, current nutrition, infection rates and iron status. The main outcome measure was the incidence of iron-deficiency anaemia in the two groups of infants, defined in the study as Hb < 11 g/dl and either plasma ferritin < 12 mcg/l or zinc protoporphyrin > 35 mcg/dl. RESULTS: Iron endowment in cord blood samples appeared similar between the two groups. The incidence of iron-deficiency anaemia was very high in these infants, at 72% by research criteria, (51% if Hb < 10.5 g/dl), but significantly higher in the infants born to anaemic mothers at all stages of the year, with overall incidence of 81% (n = 91), compared to 65% in controls (n = 112). This was not explained by differences in environmental risk factors. Anaemic mothers had not recovered adequate iron status at 6 months' postpartum, with implications for future pregnancy iron demands. CONCLUSIONS: Anaemia during pregnancy compromises the health of mothers in traditional cultures, where women tend to have several children close together after marriage, with an inadequate interval to replenish nutritional stores. Their infants also appear to be at increased risk of developing iron-deficiency anaemia, undetected at birth.

Consanguineous marriage in Jordan.

We conducted a population-based study of consanguineous marriages in Jordan. About two thousand households were interviewed. First cousin marriages were encountered in 32.03%, second cousin in 6.8%, distant relation in 10.5%, and no relation in 50% of all marriages, respectively. Inbreeding coefficients were compared with those of other countries. The most important variables affecting inbreeding were social tradition, religion, education, and place of residence--urban vs. rural. Secular trends appear rather stable since the early decades of the twentieth century, especially for first cousin marriages. Jordan society showed a deeply rooted traditional behavioral pattern when inbreeding is considered.

PIP: Consanguineous marriage in Jordan is examined in a retrospective survey of 1995 households in 1980. The sample was stratified in 2 stages and self-weighing. The research objective was to determine the extent, patterns, characteristics, significant factors affecting inbreeding, and continuity over time. Interviewers collected data on dwelling, age, education, consanguinity, marriage arrangement, religion, number of pregnancies, place of residence, contraceptive use, and parent's marital patterns. The results were 51.25% of all marriages were consanguineous: 33% among first cousins, 6.8% among second cousins, 10.5% among distant relatives, and 49.7% no relation. The inbreeding in Jordan is compared with inbreeding incidence in Lebanon, Kuwait, Egypt, and Turkey; it appears that prevalence is associated with a Muslim affiliation. The rural population had a significantly higher proportion of first cousin consanguineous marriages. Urban and semi urban dwellers had similar second marriages. There were 29.82% first cousin marriages in urban areas, 30.99% in semi urban areas, and 37.91% in rural areas. Education (literate vs. illiterate) and consanguinity was negatively correlated for all unions and male unions, i.e., higher education levels had more unrelated unions. When educational level is differentiated, the university educated group behaves like the illiterate group. Life explanation is that the "best" males are pressured to remain within the family. Female university graduates showed greater freedom in selection of husbands. 66% were living in independent households, and the other 33% with the husband's family. 80% of marriages were arranged and educational level is an important determining factor. Consanguinity of marriage was significantly associated with parent's consanguinity. Comparison with trends in the 1920s indicates that first cousin marriages have remained stable.

Diurnal patterns of pulsatile luteinizing hormone secretion in hypothalamic amenorrhea: reproducibility and responses to opiate blockade and an alpha 2-adrenergic agonist.

The pattern of pulsatile GnRH secretion is abnormal in some women with hypothalamic amenorrhea (HA) consequent to previous exercise or weight loss. Both diminished frequency pulsatile LH secretion, and by inference GnRH secretion, and normal LH pulsatility have been reported. We assessed whether the patterns of GnRH secretion varied with time by measuring plasma LH every 15 or 20 min for 24 h on 1-3 occasions during a 10-month period in 14 women with HA (a total of 24 studies). During the day, mean LH pulse frequency [1.0 +/- 0.1 (+/- SE) pulses/8 h] was lower than that in normal women in the early follicular phase of their cycles (5.1 +/- 0.6), and the frequency in individual HA patients was lower than early follicular phase values in 16 of 17 studies. The slow daytime LH pulse frequency also was a consistent finding, in that the values in repeat studies varied by less than 2 pulses/8 h in all but 1 patient. LH pulse frequency (2.0 +/- 0.4 pulses/8 h) was higher and more variable during sleep, and normal early follicular phase frequencies were found in 20% of patients with HA. The mechanisms whereby GnRH pulse frequency is reduced are not known. alpha-Adrenergic agonist drugs stimulate GnRH pulsatile secretion in rodents, but administration of the alpha 2-agonist clonidine (0.15 mg, orally, at 0800 and 2000 h) did not increase the frequency of LH pulses in 7 women (1.7 +/- 0.4 pulses/8 h). In contrast, administration of naloxone (1 mg/m2 X h, iv) for 8 h during the day to 14 patients, increased LH pulse frequency (3.3 +/- 0.5 pulses/8 h). In 8 of these 14 women, LH pulse frequency (4.9 +/- 0.4 pulses/8 h) increased into the range found during the normal early follicular phase, while in the other 6 women pulse frequency was not significantly increased (1.4 +/- 0.4 pulses/8 h). Plasma estradiol levels were similar in naloxone-responsive and unresponsive women, but spontaneous LH pulse frequency was higher at night in naloxone-responsive patients (2.9 +/- 0.6 vs. 1.4 +/- 0.3 pulses/8 h). The presence of nocturnal LH pulses did not predict responsiveness to naloxone, however, and LH pulse frequency was less than 2 pulses/8 h in 4 of the women who responded to naloxone. These data indicate that slow frequency GnRH secretion is a common finding during the day in women with HA. GnRH secretion is more variable at night, suggesting that the mechanisms involved in reducing pulsatile GnRH secretion are less effective during sleep.(ABSTRACT TRUNCATED AT 400 WORDS)

Evaluation of amputees.

During 1978 the Queen Alia Fund registered all disabled persons in the East Bank of Jordan. This paper is intended to investigate the actual condition of a sample selected from those persons registered as amputees. The registration showed a total of 696 amputees and a sample of 100 patients was randomly selected from this group. This study explored the disability, its nature and location, physical and vocational rehabilitation received, and the functional capability of the amputee. The two most important causes which lead to the amputation were mine explosions and road accidents. 32 persons received physical rehabilitation and prosthesis was recommended for 56 persons. Only 9 patients received vocational rehabilitation. Final analysis of the data showed steady increase in the past two decades with a doubling of the number from the 1960s to the 1970s. Road accidents played a major role in this increase. It is interesting to note that males and educated persons tend to use their prosthesis more than females and illiterate persons. In conclusion vocational rehabilitation remains an important element missing from the management of amputees. More emphasis and effort should be directed toward this element in order to complete the picture of an effective rehabilitation of this group of disabled persons.

Guillain-Barré syndrome: epidemiology of an outbreak.

In early January, 1976, an outbreak of gastroenteritis caused by contamination of the water supply system occurred in Salt, Jordan. This outbreak was followed by the appearance of peripheral neuropathy in 19 cases diagnosed as Guillain-Barré Syndrome. Clinically, gastroenteritis was suggestive of Shigellosis and one of nine patients with Guillain-Barré Syndrome, grew Shigella boydii. Epidemiology of the 19 cases with peripheral neuropathy is detailed. Seventeen patients had definite gastroenteritis symptoms prior to their neuropathy. The median incubation period was seven days.