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OBJECTIVES: Late presentation or diagnosis of cancer results in a poor clinical prognosis, negatively affects treatment and subsequently lowers one's chances of survival. This study aimed to identify the factors associated with late lung and colorectal cancer presentation and diagnosis in Jordan. DESIGN: This correlational cross-sectional study was based on face-to-face interviews and medical chart reviews from a cancer registry database. A structured questionnaire based on a review of the literature was used. SETTING AND PARTICIPANTS: The study participants were a representative sample of adult patients with colorectal or lung cancer who visited the outpatient clinics at King Hussein Cancer Center in Amman, Jordan, between January 2019 and December 2020, to get their first medical consultation. RESULTS: 382 study participants were surveyed, with a response rate of 82.3%. Of these, 162 (42.2%) reported a late presentation and 92 (24.1%) reported a late diagnosis of cancer. The results of backward multivariate logistic regression analyses showed that female gender and not seeking a medical advice when feeling ill combined was associated with an almost three times increased likelihood of reporting a late presentation with cancer (adjusted OR 2.97, 95% CI 1.19 to 7.43). Not having health insurance and not seeking medical advice combined was also associated with late presentation (2.5, 95% CI 1.02 to 6.12). For lung cancer, Jordanians living in rural areas were 9.29 (95% CI 2.46 to 35.1) times more likely to report late diagnosis. Jordanians who did not screen for cancer in the past were 7.02 (95% CI 1.69 to 29.18) times more likely to report late diagnosis. For colorectal cancer, those having no previous knowledge about cancers or screening programmes had increased odds of reporting late diagnosis (2.30, 95% CI 1.06 to 4.97). CONCLUSIONS: This study highlights important factors associated with the late presentation and diagnosis of colorectal and lung cancers in Jordan. Investing in national screening and early detection programmes as well as public outreach and awareness campaigns will have a significant impact on early detection to improve treatment outcomes.

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BACKGROUND: Acute otitis media (AOM) is one of the most common infectious diseases that affects children. Breastfeeding has been linked to a lower risk of AOM in the first three years of childhood. The aim of this study was to identify the association between exclusive breastfeeding and the development of acute otitis media (AOM) and investigate the influence of breastfeeding duration on the presence of AOM. METHODS: In a retrospective case-control study, a sample of 98 children (cases) who were diagnosed with AOM and 98 children (controls) who were not diagnosed with AOM and were younger than two years old were selected from the Jordan University Hospital. Medical records were used to identify children with AOM. For both the case and control groups, the children's mothers completed a self-administered questionnaire about factors linked to the incidence of AOM.The type of feeding and the duration of breastfeeding were assessed using a validated questionnaire. RESULTS: The data indicated that among children who developed AOM, 23.5%were artificiallyfed, while 22.4% and 13.3% were exclusively breastfed for 3 months and 6 months, respectively. Approximately 70.7% of the children without AOM were exclusively breastfed for 6 months, compared with only 29.3% of the children without AOM who were exclusively breastfed for 3 months.Logistic regression revealed that nonexclusive breastfeeding, exclusive breastfeeding for 3 months, and exclusive breastfeeding for 6 months were protective factors against AOM (OR = 0.23, 0.18, and 0.25, respectively; P < 0.05). A short duration of exclusive breastfeeding was considered a risk factor for the development of AOM (OR = 1.7, P < 0.05). CONCLUSIONS: The escalation of AOM is tightly connected to the early introduction of formula feeding in the first six months of life. Breastfeeding had a protective impact on the occurrence of AOM. Understanding factors that are associated with the occurrence of AOM in children may support the role of public health institutions and primary health care in the prevention and reduction of AOM episodes and the need for national health strategies to promote breastfeeding.

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BACKGROUND: Diabetic peripheral neuropathy (DPN) is the most common type of diabetic neuropathy. It accounts for significant morbidity, including lower extremity amputations. There are few studies on the prevalence of DPN among Palestinian refugees in Jordan. This study aimed to determine the prevalence of DPN and its associated factors among Palestinian refugees with diabetes in the Nuzha area of Jordan, using the Michigan Neuropathy Screening Instrument (MNSI). METHODS: A cross-sectional study was conducted at the UNRWA Nuzha Health Centre, Amman, Jordan, during the first quarter of 2016 (Jan 2-Mar 31, 2016). The Nuzha Health Centre was randomly chosen from the UNRWA clinics in Jordan. Study participants were selected by systematic random sampling. The number of participants was decided with Cochran's formula and adjusting the sample size by use of the finite population correction equation. 343 patients with diabetes were assessed for DPN using the history and physical assessment sections of the MNSI. We generated descriptive statistics, and tested for associations between variables using univariate and multivariate logistic regression analysis to identify the best subset of predictors for the presence of DPN. We used SPSS version 22 to input and analyse data. This study was approved by the UNRWA Jordan Field Office and the Institutional Review Board at the University of Jordan, and by the Michigan Diabetes Research Centre, which gave its permission to use the MNSI. Written informed consent was obtained from each participant. FINDINGS: Prevalence of DPN was 11% (37 of 343) based on the history section and 36% (122 of 343) based on the physical assessment section of the MNSI. Multivariate logistic regression revealed that significant predictors for DPN based on the history section of the MNSI were education level and duration of diabetes. Compared with participants with no education, the odds ratio (OR) for DPN was 0·13 (95% CI 0·04-0·49, p=0·0023) for participants with elementary education, 0·11 (0·03-0·49, p=0·0035) for those with high school education, and 0·04 (0·01-0·41, p=0·0070) for those with a diploma. Compared with participants who had diabetes for less than 10 years, the OR for DPN was 7·69 (1·99-30·30, p=0·0031) for those who had diabetes for 10-19 years and 32·26 (6·76-142·86, p<0·0001) for those who had diabetes for 20 years or longer. However, the predictors for DPN based on the physical assessment part of MNSI were age, duration of diabetes, and type of treatment for diabetes. Compared with participants aged 70 years or older, the OR for DPN was 0·18 (0·04-0·89, p=0·036) for those aged 40-49 years and 0·22 (0·06-0·82, p=0·024) for those aged 50-59 years. Compared with participants who had diabetes for less than 10 years, the OR for DPN was 32·26 (13·70-76·92, p<0·0001) for those who had diabetes for 10-19 years and 200 (34·48-1000, p<0·0001) for those who had diabetes for 20 years or longer. The OR for DPN was 0·23 (0·08-0·70, p=0·0094) for participants who were treated with oral hypoglycemic agents alone, compared those who were treated with insulin and oral hypoglycaemic agents. INTERPRETATION: The prevalence of DPN is high among Palestinian refugees with diabetes in the Nuzha area, Jordan, consistent with the results of other studies of DPN in individuals with diabetes. There is a need for early detection and regular screening for DPN in patients with diabetes, with special attention given to patients with risk factors for DPN. FUNDING: None.

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Global health threats including epidemics and climate change, know no political borders and require regional collaboration if they are to be dealt with effectively. This paper starts with a review of the COVID-19 outbreak in Israel, Palestine and Jordan, in the context of the regional health systems, demography and politics. We suggest that Israel and Palestine function as one epidemiological unit, due to extensive border crossing of inhabitants and tourists, resulting in cross-border infections and potential for outbreaks' transmission. Indeed, there is a correlation between the numbers of confirmed cases with a 2-3 weeks lag. In contrast, Jordan has the ability to seal its borders and better contain the spread of the virus. We then discuss comparative public health aspects in relation to the management of COVID-19 and long term adaptation to climate change. We suggest that lessons from the current crisis can inform regional adaptation to climate change. There is an urgent need for better health surveillance, data sharing across borders, and more resilient health systems that are prepared and equipped for emergencies. Another essential and currently missing prerequisite is close cooperation within and across countries amidst political conflict, in order to protect the public health of all inhabitants of the region.

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Introduction: Breast cancer is the most common cancer amongst females in Jordan. The study aimed to estimate the total direct medical cost of breast cancer from a healthcare provider's perspective.Methods: A retrospective cohort study was done to include all Jordanian females who were diagnosed with breast cancer at two leading public providers of cancer care in Jordan, Bashir Hospital and the University of Jordan Hospital. Data were extracted from the Jordan Cancer Registry (JCR) from 2011 to 2014 including demographic, clinical, and economic data of the patient.Results: A total of 877 and 665 patients were included in the first and second year after diagnosis, respectively. Costs increased in the advanced stages; costs for stages 0, I, II, III, and IV were Jordanian dinars)JD(6,749.94 ($9,517.42), JD 5,960.46 ($8,404.25), JD 8,003.58 ($11,285.05), JD 9,390.59 ($13,240.73), and JD 9,587.44 ($13,518.29), respectively. Treatment costs were the main cost driver across all stages.Conclusions: This analysis offers insight into costs, cost drivers, and resources utilization incurred by breast cancer patients in Jordan. Two major hospitals in Jordan can play a key informative role in future cost-effectiveness of breast cancer screening and therapeutic treatments in the different stages of cancer.

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Plastic made with bisphenol A (BPA) produces trans-generational changes in genes and behavior. It has been positively linked to obesity and thyroid dysfunction. This study aimed to detect the presence of BPA in polycarbonate plastic (PC) baby bottles. Fifteen PC baby bottles with a clear indication of BPA free/safe/clear were randomly selected. High-performance liquid chromatography (HPLC) tests were used to detect residual or migrating BPA post three stress tests. An estimated intake of BPA among children was calculated then compared to the universal tolerable daily intake (TDI). Around 27% of bottles had detectable amounts of residual BPA in the first test, 100% released migrating BPA in the second and third tests. A significant positive linear trend in migrated BPA levels was observed over the three consecutive tests P < 0.0001. Approximately 73.5% of the accounted variability in BPA levels was due to these stress tests P < 0.0001. Babies from 0 to 3 months are expected to consume 0.8 to 23.8% of their safe TDI of BPA just by using plastic bottles between the first time of usage and after 60 washes (estimated 15 to 20 days of usage). Although no bottles have shown a risk of BPA intake exceeding TDI, the combined use of BPA bottles with other plastic utensils might result in reaching it. It is advisable to refrain from using BPA-containing plastic bottles or be cautious about usage duration. Manufacturers should indicate a clear margin of usage duration. Four baby bottle brands showed the least BPA leaking (Baby King, Camera, Sweet Baby, and Farlin).

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Background. Recently, the percentage of older adults in developing countries has increased significantly. Objective. This study examined patterns and factors associated with primary health care services utilization in the past 1, 6, and 12 months. Method. A cross-sectional study design was used to collect data from 190 older adults in the Irbid governorate of Jordan. Results. Primary health care services were used by less than half of the participants in the past 1 month, by 68.4% in the past 6 months, and by 73.8% in the past 12 months. Primary health care (PHC) services use was associated with age, education level, tobacco use, chronic illnesses, perceived general health status today, a physical component summary score, employment, and perceived general health status in the past 6 and 12 months. The primary predictor of PHC services use at 1, 6, and 12 months was chronic illnesses (OR = 13.32), (OR = 19.63), and (OR = 17.91), respectively. Conclusion. Although many factors were associated with PHC service utilization, the strongest predictor of PHC service utilization was chronic illnesses.