Nursing Research in Arab Countries: Current Status, Trends, Challenges, and Opportunities

Introduction

Twenty-two Arab countries comprise the League of Arab States. While united in Arab identity, diversities among these countries exist at many levels. Conducting and publishing research in the Arabic speaking countries is an essential pillar for improving the status of the nursing profession.

Purpose

The purpose of this study is to assess the current status, trends, challenges, and opportunities of nursing research in Arab countries.

Methodology

An integrative review was conducted using (1) Index Medicus for the Eastern Mediterranean Regional Office Database Journals Directory (IMEMR), (2) the Iraqi Academic Scientific Journals Database (IASJD), (3) Ulrichsweb (UW), (4) The Geneva Foundation for Medical Education and Research/Middle Eastern Journals (GFMER), (5) the Nursing Journal Directory (NJD), (6) the Directory of Open Access Journals (DOAJ), and (7) Google Scholar. Journals and articles that met inclusion criteria were accessed, retrieved, reviewed, and subjected to content analysis by three authors, two of which were fluent in English, French, and Arabic languages. A third author fluent in all three languages confirmed the findings.

Results

Nursing research in Arabic-speaking countries has evolved over the past decades but is still lacking compared to global nursing research. Moreover, it was found to be largely situated within academic institutions and linked to tenure and promotion requirements.

Conclusion

Nursing journals in Arabic-speaking countries do not adequately represent that overall region and are limited in access.

Reducing Violence Against Women and Girls in the Arab League: A Systematic Review of Preventive Interventions

The UN's Sustainable Development Goal #5 (Gender Equity) includes violence against women and girls (VAWG), considering it as a violation of the rights of women and girls. The variety of risk factors for VAWG in Arab countries suggests the need to identify effective interventions to guide practitioners and policy makers. A systematic review of preventive interventions across the Arab League examined the outcomes of VAWG. Authors registered the study on the prospective register of systematic reviews database. Authors conducted the search for evidence up to 2023. Database searching identified 1,502 studies and after application of the eligibility criteria, 17 studies remained for inclusion. Quality appraisal used the Mixed Methods Appraisal Tool. Evidence emerged from eight Arab countries. Interventions occurred at the primary, secondary, and tertiary levels of prevention. However, only two studies employed interventions using more than one level of prevention, which considered systems strengthening and the development of community solidarity networks. The evidence revealed a lack of clear evaluation and evidence for the effectiveness of interventions and prevention alongside reactive approaches, with no evidence as to how systems may reduce or prevent VAWG. One main issue is patriarchal dominance in Arab countries creating the lack of a collective female voice in any of the evidence. However, Arab countries can change with support. Achieving the UN's Sustainable Development Goal #5 by 2030 means interventions and programs need to include more than one prevention level, consider systems and include the collective female voice.

Student Self-assessment: Reflecting on Physician Assistant Educator's Perceptions and Current Practices in Physician Assistant Training

PURPOSE

The purpose of this study was to examine relationships between physician assistant (PA) educators' perspectives on students' self-assessment (SA) accuracy and students' use of SA education practices and types of abilities assessed.

METHODS

Using correlation analysis and a novel, online survey, PA educators were asked about their perceptions of students' SA accuracy in relation to SA educational activities and assessed abilities.

RESULTS

A total of 308 educators responded. Most respondents used at least one type of SA activity, with feedback and practice being the most common types and comparative assessment, the least common type. Most respondents indicated that students self-assess noncognitive abilities more than cognitive abilities, with SA of communication skills occurring most. Spearman's correlation coefficient was used for correlation analysis with a significant, small correlation noted between the frequency of activities and educators' overall perceptions of students' SA accuracy (r = 0.15, P = .02) and SA accuracy of cognitive abilities (r = 0.17, P = .02). Educators' perceptions of students' SA accuracy were positively skewed, regardless of student training level (ie, didactic and clinical training phases). A mild predictive relationship exists between overall perception of students' SA accuracy and how frequently educators use SA activities (r = 0.29, P = .05).

CONCLUSION

Although respondents indicated they used practice and feedback activities, providing instruction on how to self-assess and using comparative evaluations to calibrate SAs will improve accuracy. Further research is needed to understand why educators perceive PA students' SA abilities as more accurate, regardless of training level.

Interventions using the Qur'an to promote mental health: a systematic scoping review

BACKGROUND

Accommodating and addressing the beliefs and attitudes of Muslim patients, means designing culturally competent mental health services. Practicing Muslims around the world often use the Qur'an when seeking guidance for health.

AIMS

The aim of this study was to identify interventions using the Qur'an as a promoting factor for mental health.

METHODS

The paucity of academic literature in the area meant a systematic scoping review of the evidence was appropriate. Conducting the search for peer-reviewed evidence used six databases, searching for grey literature used Google Scholar, for evidence published up to 29^th December 2022. Analysis used the Patterns, Advances, Gaps, Evidence for practice and Research recommendations (PAGER) framework for scoping reviews to report the findings clearly and accessibly.

RESULTS

Out of 1590 articles from databases and 35 from other sources (n = 1625), 79 full-text articles meeting the inclusion criteria were retrieved. Further assessment for eligibility, excluded 35 articles; leaving 44 studies in the final analysis. Interventions identified Salah and supplicant praying, recitation, reading, memorizing and listening to the Qur'an to reduce anxiety, depression and stress and increase quality of life and coping. There was a paucity of evidence from Western countries utilising the Qur'an to support mental health and wellbeing, suggesting a lack of cultural accommodation. Interventions tended to be mostly biomedical and excluded exploration of psychosocial factors such as the effect of social support.

CONCLUSIONS

Future research could utilise the Qur'an for Muslim patients, integrating it into routine health care interventions and delivery platforms and more closely relating to Islamic lifestyles. This aims to promote mental health and wellbeing, working towards the WHO 2013-2030 MHAP building mental health and psychosocial support capacity and the United Nations Sustainable Development Goal 3, good health and wellbeing, by 2030.

A comparative review of nutrition education intervention duration and impact on reduction of prediabetes or Type 2 diabetes mellitus among adults aged 45 years or older

Prediabetes and Type 2 diabetes mellitus (T2DM) is increasingly prevalent and both conditions have a variety of comorbidities. There are many programs aimed at the reduction or prevention of prediabetes and/or T2DM. However, only a few studies have evaluated the effect of intervention duration and evidence-based frameworks on specific populations at risk for prediabetes or T2DM. This review evaluated evidence-based lifestyle intervention programs to determine whether the duration of programming relates to the efficacy of evidence-based lifestyle change interventions. The aim was to assess relevant outcomes of these interventions in prediabetic or T2DM individuals aged 45 and older. The PRISMA framework was followed. Searches systematically screened and evaluated 2654 articles. Thirteen articles met the inclusion/exclusion criteria. Databases searched included: PubMed; SCOPUS; ProQuest; Biomed Central; SpringerLink; ScienceDirect; EBSCOHost; JSTOR; Taylor & Francis; Wiley Online; BioOne; CINAHL; SAGE Journal; and Google Scholar (2009-2022). Identifying the most effective timeframe for lifestyle intervention programming to reduce the risks associated with prediabetes/T2DM can help providers develop appropriate educational initiatives for patients at risk for pre-diabetes and/or T2DM. After screening, there were 13 studies which met the review criteria. All of the studies included in this comparative review used evidence-based interventions. Evidence-based lifestyle intervention programs that are ≥12 months produced significant and consistent results in mediating outcomes related to prediabetes/T2DM than <12-month programs in adults aged 45 years and older.

Female genital mutilation and cutting in the Arab League and diaspora: A systematic review of preventive interventions

OBJECTIVES

Female Genital Mutilation and Cutting (FGM/C) is an act of gender-based violence (GBV) and a global public health issue with well-documented adverse outcomes. With the rise in global migration, there is an increasing prevalence of FGM/C among Arab diaspora living in the West and Global South. What remains unclear is how to reduce the practice. This study was designed to identify interventions exerting an effect on reducing the practice of FGM/C.

METHODS

A systematic review of peer-reviewed articles was conducted on interventions targeting individuals and/or the broader community to prevent FGM/C within the Arab League and its diaspora, up to December 2021. Databases searched included PubMed, Medline, Web of Science, PsycINFO, EMBASE, CINAHL, BIOSIS, ASSIA and Scopus. Quality assessment used the Mixed Methods Appraisal Tool (MMAT) 2018.

RESULTS

Twelve of 896 studies met the inclusion criteria. Eight interventions relied entirely on education with short-term gains but unchanged practices. Three interventions used social marketing and mixed media. Only one study took a multi-sectoral approach.

CONCLUSIONS

At a macro level, opportunities to reduce or to end the practice of FGM/C exist through legislation, policy, a public health approach grounded in gender equality and human rights. Using multi-sectoral actions that consider the social context and challenge social norms at macro, meso and micro levels appears more effective than individual-level interventions. Promoting advocacy and developing supportive environments to reduce GBV, enhance gender equality and empower communities is crucial for interventions to succeed and achieve the Sustainable Development Goal target of FGM/C abandonment by 2030.

Cochlear Implantation in the Active Duty Military Population: A Survey Assessing Military Readiness and Satisfaction

OBJECTIVE

Evaluate the impact of cochlear implantation (CI) on retention for United States active duty (AD) service members.

STUDY DESIGN

Retrospective observational study.

SETTING

Tertiary military CI centers.

PATIENTS

AD service members who underwent CI and completed a telephonic survey.

MAIN OUTCOME MEASURES

The ability for military personnel to maintain AD status following CI as determined by the nonvolitional hearing-related AD separation rate and whether subjects would recommend CI to other qualified candidates.

RESULTS

Twenty AD service members who underwent CI between 2004 and 2020 completed a telephonic survey. Fifteen (75%) were single-sided deafness (SSD) and five were traditional CI candidates. The mean age was 40.3 years (range 27.5-64.3), 19 (95%) were male, and 12 (80%) were Caucasian. Ten (50%) were officers and 14 (70%) were noncombat support personnel. Idiopathic sudden sensorineural hearing loss was the most common cause of hearing loss (8, 40%) followed by occupational noise exposure (4, 20%). Sixteen (80%) maintained AD status yielding 46.15 person-years of AD service following CI. For SSD, 14 (93%) maintained AD status yielding 40.54 person-years of AD service. The nonvolitional hearing-related patient separation rate for CI recipients with bilateral hearing loss was 35.65 cases per 100 AD person-years and 0 cases per 100 person-years for SSD candidates. Nineteen (95%) stated they would recommend CI to other AD CI candidates.

CONCLUSIONS

The vast majority of AD CI recipients, and particularly those with SSD, are able to remain on AD after surgery and report a high degree of satisfaction with their implant.

A Narrative Review of Ethnic Minority Studies for Faith-Based Health Promotion Interventions with Special Reference to the Contemporary Christian Nurse

Heart disease, diabetes mellitus (DM) type 2, and obesity are three of the most prevalent diseases in the USA. Some obesity-related comorbidities are disproportionately higher within African-American and Hispanic communities. While governmental and local health programs offer educational opportunities encouraging long-term health behavior changes, the most accessible programs have been through faith-based communities. This narrative review investigates the outcomes of faith-based wellness programs on Latino and African-American populations with respect to general health and wellness, obesity management, DM type 2, and hypertension. Perceived authority of faith community nurses, faith leaders, and accountability and encouragement provided by faith communities are critical. Long-term behavior change is positively affected by elements faith-based organizations can provide: cultural appropriateness, community support, and self-efficacy.

A community of practice in dental education: A phenomenon of newcomers becoming oldtimers

OBJECTIVES

Community of practice (CoP) members develop cooperative learning history with shared cases, techniques, and concepts. A 2020 study was designed to explore participants' perceptions toward learning in the dental education CoP.

METHODS

The Institutional Review Board exempted (AZ #1355) study involved an incidental population of third- and fourth-year dental students (N = 285) and resulted in a 43.5% response rate. The online Community of Practice Assessment Scale, consisted of Likert-style, check box items, and one open-ended question. Survey responses were categorized as Strongly Agree (1), Agree (2), No opinion (3), Disagree (4), and Strongly Disagree (5). Univariate analyses and descriptive statistics were used to analyze study variables (domain, community, and practice).

RESULTS

Overall the learning domain is most strongly perceived by participants with mean scores ranging from 1.59 to 1.61. Responses assessing practices within the CoP had mean scores ranging from 1.72 to 1.90. Similarly, responses assessing the community ranged from 1.65 to 1.81. "Builds Knowledge and Shared Learning" was the characteristic participants most strongly agreed as beneficial with a 1.58 mean score. Participants agree that the CoP "Captures and Stores Tacit and Explicit Knowledge" with a mean score of 1.90. There was a 25.6% response rate to the open-ended question. Two themes evolved: the need for calibration and more shared learning.

CONCLUSION

Based on study results, participants strongly agreed or agreed in opinions about CoP learning resources (faculty, staff, technology, and other students) benefitting their learning. The CoP provides an optimal environment for preparing competent new dental professionals.

Postsecondary nutrition program education in the hashemite Kingdom of Jordan: A brief report

BACKGROUND

Obesity is a growing public health concern in Jordan, which has experienced a noticeable transition associated with increased morbidity and mortality, due to nutrition-related noncommunicable diseases. The nutrition profession has also advanced in Jordan, but the expansion is not as robust as changes happening in other healthcare sectors. This brief report examines the current nutrition-affiliated programs offered in postsecondary institutions in Jordan.

METHODS

An electronic review of university websites and department webpages of all private and public universities in Jordan was conducted to identify the nutrition programs offered.

RESULTS

A total of 29 universities were identified; 10 public and 19 private universities. Eight universities (three private and five public) offered nutrition degree programs; all eight offered bachelor's degrees in human nutrition. One offered a PhD in nutrition and dietetics, and three offered master's degrees in nutrition and food sciences.

DISCUSSION

Postsecondary education in Jordan is progressing; however, few institutions offered nutrition education programs that prepare students to practice. The nutrition profession still lacks an official organization in Jordan compared to its European and U.S. counterparts. Establishment of a nutrition and dietetics organization that cooperates with universities to develop national recognitions and guidelines is necessary.

Attitudes toward sweetened soft drinks and consumption patterns among Saudi women: A cross-sectional study

Although sweetened soft drink consumption (SDC) has negative consequences on health, this dietary habit is common among the Saudi population (Saudi Arabia). Food selection and consumption are complex behaviors and associated with several constructs described by social cognitive theory. This study assessed the pattern of sweetened SDC and its associated behavioral and theoretical factors, with focus on attitude and expectations related to SDC among Saudi women. Participants (n = 773) answered an online questionnaire on SDC patterns (frequency of consumption and quantity) and attitudes influencing those patterns. Association of attitudes with frequency of sweetened SDC was assessed using Spearman's test that revealed a positive and significant association between frequency and quantity of SDC (Spearman's rho = 0.34, df = 771, p < .0001). Highest correlations were observed between frequency of consumption and positive attitudes toward the perception of sweetened soft drinks as indispensable while eating, enjoyable, and value indispensable during social gathering (Spearman's rho = 0.58, 0.55 and 0.40, respectively, df = 771, p < .0001). Multiple regression analysis of attitudes showed considering soft drinks enjoyable and essential at eating were positively associated with consumption. Saudi Women are consuming soft drinks at high rates despite self-reporting this behavior as unhealthy. Social cognitive factors could potentially be predictors of unhealthy dietary behaviors among Saudi women. Designing nutrition education campaigns and culture-tailored information is warranted.

Ancel Benjamin Keys (1904-2004): His early works and the legacy of the modern Mediterranean diet

Culturally congruent dietary patterns have evolved with geographic and societal traditions and can be traced as far back as pre-Hellenistic Greece. Today, the modern Mediterranean diet (MDiet) is recognized internationally as an anti-obesogenic cardioprotective dietary model consisting of plant-based foods native to the Mediterranean basin, fish, olive oil, and an active lifestyle. With the assumption that obesity and heart disease rates adversely affected life expectancy, the MDiet was identified by Dr Ancel Keys as a primary characteristic among people-groups largely immune to these trends. Following extensive research on how food quality affected human performance, Keys engineered the largest ecologic investigation of dietary habits and their effects on heart disease and longevity known as the Seven Countries Study. A new understanding of how regionally and culturally specific diets affected entire populations led to the introduction of the MDiet to the global public health community. This historiographic portrait of Dr Keys describes his humble beginnings, highlights critical points in his career, discusses his seminal research into diet and culture as protective agents, and details his legacy as the pioneer of the modern MDiet.

Psychological Stress and Cellular Aging in Cancer: A Meta-Analysis

BACKGROUND

Epidemiological evidence continues to accumulate on the effect of psychosocial and behavioral factors in relation to cancer risk, progression, and mortality.

MATERIAL AND METHODS

This article presents the current evidence on the relationship between psychological stress and the risk of cancer and cellular aging process. Ten databases were searched to identify publications up to September 2019. References from retrieved articles were also reviewed. We included nine review papers and 26 cohort or case-control studies based on inclusion/exclusion criteria.

RESULTS

Results of previously published review articles did not show consistent evidence for the association between cancer risk and psychological stress, while previous evidence is stronger regarding the role of chronic psychological stress on cancer growth and metastasis and aging. In seven observational studies, severe life events, anxiety, depression, insufficient social support perception, or avoiding coping strategy were significantly associated with breast cancer risk. For other specific types of cancer, 11 studies reported increased risk factors for stressful life events, and two others found increased mortality or a decline in treatment adherence.

CONCLUSIONS

Recent epidemiological evidence generally suggests psychosocial factors may be considered risk factors for specific types of cancer and play a key role in the cellular aging process. Understanding molecular mechanisms of the stress interaction is important in cancer management and prevention. The psychological stressors should be considered when developing or evaluating change in psychosocial practice.

Bilateral subtrochanteric femur insufficiency fractures after bariatric surgery: a case report

There have been case reports of proximal femur insufficiency fractures in patients who have previously undergone bariatric surgery. We present a follow-up case of a patient who developed bilateral complete proximal femur insufficiency fractures several years after bariatric surgery. Our patient underwent bilateral intramedullary fixation with a satisfactory postoperative outcome. We review and discuss the definition and pathogenesis of atypical femur fractures (AFFs), which may represent a larger category of insufficiency fractures not exclusive to bisphosphonate use, which includes patients with fractures after bariatric surgery.

Revisiting Desmond Doss (1919-2006): Merging Combat Medicine and Benevolence on the Battlefield

Conscientious objectors are typically defined only by their unwillingness to serve in the armed forces. Desmond Doss participated in World War II as a combat medic and a conscientious objector by providing emergency medicine on active battlefields while refusing to handle a weapon or harm another human being. Born and raised with humility, Doss developed spiritually as a Seventh Day Adventist. Although fixated on the Ten Commandments and "Thou shall not kill," Doss felt a call to serve and voluntarily enlisted in the U.S. Army with aspirations of becoming a combat medic. Throughout his training he was met with physical, spiritual, and political obstacles as his superiors unsuccessfully tried to convince him and eventually to force him out of the military or to take up arms and fight. Doss was granted his request as a combat medic, was not required to handle a weapon or fight, and was deployed with the 307th Infantry Regiment overseas. His heroism on the battlefield saved hundreds of lives and earned him the Medal of Honor. A thorough yet concise examination of Doss' formative years, the obstacles presented by the country he aimed to serve, how he evolved from a conscientious objector to a combat medic worthy of emulation, and his lasting legacy is a necessary reminder of what we risk when courageous people are limited by outdated and potentially unconstitutional policies and perceptions.

Fruits and vegetables embedded in classic video games: a health-promoting potential?

The proliferation of the video game era has increased sedentary behaviours among children and adolescents. Contemporary interventions involve the use of video games to introduce fruit and vegetable (F&V) consumption among children and adolescents. A comprehensive list of licenced video games (n = 671) released for the Nintendo Entertainment System (NES) console were reviewed for thematic content and qualitative characteristics of the game's activity relevant to F&V. Seventy-five video games were included in the study sample and categorised by release year, prevalence of F&V, and thematic content. Mild associations were found comparing release year to F&V totals (r = 0.21) and release year to theme (r = 0.19). F&V themes embedded within classic video games could serve as health-promoting lessons for forthcoming video games. Future games produced by the video gaming industry should continue to focus on nutrition-embedded messages promoting F&V. Video game development and marketing could be an avenue that incorporates healthy nutrition themes.

Texting Brief Podcasts to Deliver Faculty Development to Community-Based Preceptors in Longitudinal Integrated Clerkships

INTRODUCTION

Longitudinal integrated clerkships (LICs) are an increasingly popular clerkship model that relies heavily on community-based preceptors. The availability of an engaged and prepared community-based faculty is crucial to the success of these programs. Teachers in these programs are often geographically separate from medical school campuses, are engaged in busy practices, and have limited time to devote to faculty development activities.

METHODS

We created a series of five brief faculty development podcasts directed towards community-based teachers in LICs from three US medical schools. Topics included encouraging continuity, bedside teaching, encouraging student ownership of patients, communicating and managing patient results between clinic days, and choosing the right patients for continuity. The podcasts were sent via a grouped text message just prior to preceptors' morning commute time. Pre- and postsurveys assessed the acceptability and effectiveness of the podcasts.

RESULTS

Among the 33 postintervention survey responders, 27 (81.8%) listened to at least three podcasts, 21 (63.6%) found them moderately or very helpful, 23 (69.7%) perceived that the podcasts altered their teaching style, 23 (69.7%) would likely or highly likely listen to further podcasts, and 18 (54.5%) would likely or highly likely recommend the podcasts to colleagues.

DISCUSSION

In a cohort of multispecialty faculty teaching in LICs, educational podcasts were well received and perceived by preceptors to impact their teaching style. Texting these podcasts to other community-based preceptors may offer an effective strategy for providing faculty development to busy clinicians.

[Ethical, pedagogical, socio-political and anthropological implications of quaternary prevention]

The concept of quaternary prevention, resulting from a reflection on the doctor-patient relationship, is presented as a renewal of the ageold ethical requirement: first, a doctor must not harm; second, the doctor must control himself/herself. The origin of the concept, its endorsement by the World Organization of Family Doctors (WONCA) and the European Union of General Practitioners (UEMO), its dissemination, and the debates to which it has given rise, are presented by a panel of authors from 12 countries and 3 continents. This collective text deals more specifically with the ethics of prevention, the importance of teaching Quaternary prevention and Evidence Based Medicine, the social and political implications of the concept of quaternary prevention, and its anthropological dimensions.

Peer-Reviewed Veterinary Journals From Arabic-Speaking Countries: A Systematic Review

BACKGROUND

The prevalence of diseases of foodborne and zoonotic origin in Arabic-speaking countries highlights the importance of collaboration between human and animal health professionals. However, accessibility of research and evidence-based practices in these countries is not well characterized. This brief report determines the availability of professional veterinary journals within the Arabic-speaking region.

METHODS

An electronic search using 6 databases assessed for publication period, activity status, and available languages incorporated all aspects of veterinary medicine and specialties.

RESULTS

Among 29 veterinary journals identified, the oldest current publication originated 63 years ago, with 10 journals currently interrupted or ceased. All 19 currently active journals are available electronically as open access, with 8 also offered in paper format. Veterinary journals published within Arabic-speaking countries are predominantly produced in Egypt, Iraq, and Sudan.

CONCLUSION

Electronic access is lacking compared with English-speaking countries, and there is a lack of journals with an Arabic-language option. The reasons associated with language options in veterinary publications are not immediately apparent, yet may highlight differences among public health, health education, and zoonotic professionals and the populations they serve. Veterinary journals in Arabic-speaking countries do not adequately represent the overall region and are limited in access. Further evaluation of regional culture and publisher preferences is indicated to identify new collaboration opportunities among health professionals and local stakeholders.