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Background The global expansion of online gaming raises worries about its impact on adolescent well-being, particularly regarding Internet Gaming Disorder (IGD) and its association with social health and bullying. This study addresses a research gap in the Middle East by exploring gender-specific trends in gaming habits, social perceptions, and the prevalence of IGD among adolescents in Jordan. Utilizing the Social Cognitive Theory (SCT), the study aimed to identify predictors of IGD and exposure to social bullying. Methods 403 adolescents (aged 10–17) were selected from the northern Jordan in this cross-sectional, survey-based study. Participants responded to the Arabic version of the IGD-20 scale, in addition to items about their gaming habits, social perceptions, and exposure to social bullying. Furthermore, was used to measure IGD. Linear regression models were employed to identify factors predicting IGD scores and exposure to social bullying. Results 52.9% of the participants were at risk for or had IGD. Significant gender differences were found, with males spending more time gaming ( p  = 0.012) and preferring competitive games, while females favored “Fashion/dress” games. Key predictors of higher IGD scores were daily gaming hours, a perception of gaming as harmful, and poor social relationships. A higher IGD score also predicted increased exposure to social bullying. Crucially, gender did not significantly predict IGD or social bullying in the final models. Conclusion Our findings, guided by SCT, suggest that gaming habits are often gender-specific, however, the core risk factors for IGD are not. Developing IGD is more closely tied to excessive gaming, poor social relationships, and exposure to bullying. So, effective measures should promote healthy gaming habits and foster strong social support systems for all adolescents, rather than exclusively targeting a specific gender. No Patient or Public Contribution. Clinical trial number Not applicable. Graphical Abstract

Background Balanced Scorecard (BSC) has been implemented for three decades to evaluate and improve the performance of organizations. To the best of the researchers’ knowledge, no previous systematic review has performed a comprehensive and rigorous methodological approach to figure out the impact of BSC implementation in Health Care Organizations (HCO). Aims The current work was intended to assess the impact of implementing the BSC on Health Care Workers’ (HCW) satisfaction, patient satisfaction, and financial performance. Methods The authors prepared the present systematic review according to PRISMA guidelines. Further, the authors customized the search strategy for PubMed, Embase, Cochrane, Google Scholar databases, and Google’s search engine. The obtained studies were screened to isolate those measuring scores related to HCW satisfaction, patient satisfaction, and financial performance. The Risk of Bias (RoB) in the non-Randomized Intervention Studies (ROBINS-I) tool was used to assess the quality of observational and quasi-experimental studies. On the other hand, for the Randomized Controlled Trials (RCTs), the Cochrane (RoB 2) tool was used. Results Out of 4031 studies, the researchers included 20 studies that measured the impact of BSC on one or more of the three entities (HCW satisfaction, patient satisfaction, and financial performance). Throughout these 20 studies, it was found that 17 studies measured the impact of the BSC on patient satisfaction, seven studies measured the impact on HCW satisfaction, and 12 studies measured the impact on financial performance. Conclusion This systematic review provides managers and policymakers with evidence to support utilizing BSC in the health care sector. BSC implementation demonstrated positive outcomes for patient satisfaction and the financial performance of HCOs. However, only a mild impact was demonstrated for effects related to HCW satisfaction. However, it is worth noting that many of the studies reflected a high RoB, which may have affected the impacts on the three primary outcomes measured. As such, this systematic review reflects the necessity for further focus on this area in the future. Moreover, future research is encouraged to measure the real and current impact of implementing BSC in HCO during the pandemic since we did not find any.

Background Nurses’ burnout might affect their quality of life, productivity and nursing care services. Aim The aim of this systematic review was to systemically review the relationship between nurses’ burnout and quality of life and to introduce practical recommendations to reduce nurses’ BO and improve their QOL. Methods In April 2021, MeSH terms ((\"Nurses\"[Mesh]) AND \"Burnout, Professional\"[Mesh]) AND \"Quality of Life\"[Majr] were used to search five electronic databases: CINAHL, PubMed, Medline, Psychology and Behavioral Sciences Collection and Google Scholar. Results The search produced 21 studies exploring nurses’ burnout and their quality of life within the last ten years (2009–2021). Most of these studies found significant relationships between the burnout dimension(s) and quality of life dimension(s) among the nurses. Conclusion Nurses have moderate to high levels of burnout and were negatively associated with poor quality of life. Interventional programs are needed to decrease nurses’ burnout and improve their quality of life.

Background Huge efforts are being made to control the spread and impacts of the coronavirus pandemic using vaccines. However, willingness to be vaccinated depends on factors beyond the availability of vaccines. The aim of this study was three-folded: to assess children’s rates of COVID-19 Vaccination as reported by parents, to explore parents’ attitudes towards children’s COVID-19 vaccination, and to examine the factors associated with parents’ hesitancy towards children’s vaccination in several countries in the Eastern Mediterranean Region (EMR). Methods This study utilized a cross-sectional descriptive design. A sample of 3744 parents from eight countries, namely, Iraq, Jordan, Kuwait, Lebanon, Palestine, Qatar, Saudi Arabia (KSA), and the United Arab Emirates (UAE), was conveniently approached and surveyed using Google forms from November to December 2021. The participants have responded to a 42-item questionnaire pertaining to socio-demographics, children vaccination status, knowledge about COVID-19 vaccines, and attitudes towards vaccinating children and the vaccine itself. The Statistical Package for Social Sciences (SPSS- IBM, Chicago, IL, USA) was used to analyze the data. A cross-tabulation analysis using the chi-square test was employed to assess significant differences between categorical variables and a backward Wald stepwise binary logistic regression analysis was performed to assess the independent effect of each factor after controlling for potential confounders. Results The prevalence of vaccinated children against COVID-19 was 32% as reported by the parents. Concerning parents’ attitudes towards vaccines safety, about one third of participants (32.5%) believe that all vaccines are not safe. In the regression analysis, children’s vaccination was significantly correlated with parents’ age, education, occupation, parents’ previous COVID-19 infection, and their vaccination status. Participants aged ≥50 years and those aged 40-50 years had an odds ratio of 17.9 (OR = 17.9, CI: 11.16-28.97) and 13.2 (OR = 13.2, CI: 8.42-20.88); respectively, for vaccinating their children compared to those aged 18-29 years. Parents who had COVID-19 vaccine were about five folds more likely to vaccinate their children compared with parents who did not receive the vaccine (OR = 4.9, CI: 3.12-7.70). The prevalence of children’s vaccination in the participating Arab countries is still not promising. Conclusion To encourage parents, vaccinate their children against COVID-19, Arab governments should strategize accordingly. Reassurance of the efficacy and effectiveness of the vaccine should target the general population using educational campaigns, social media, and official TV and radio channels.

Background The balanced scorecard (BSC) has been implemented to evaluate the performance of health care organizations (HCOs). BSC proved to be effective in improving financial performance and patient satisfaction. Aim This systematic review aims to identify all the perspectives, dimensions, and KPIs that are vital and most frequently used by health care managers in BSC implementations. Methods This systematic review adheres to PRISMA guidelines. The PubMed, Embase, Cochrane, and Google Scholar databases and Google search engine were inspected to find all implementations of BSC at HCO. The risk of bias was assessed using the nonrandomized intervention studies (ROBINS-I) tool to evaluate the quality of observational and quasi-experimental studies and the Cochrane (RoB 2) tool for randomized controlled trials (RCTs). Results There were 33 eligible studies, of which we identified 36 BSC implementations. The categorization and regrouping of the 797 KPIs resulted in 45 subdimensions. The reassembly of these subdimensions resulted in 13 major dimensions: financial, efficiency and effectiveness, availability and quality of supplies and services, managerial tasks, health care workers' (HCWs) scientific development error-free and safety, time, HCW-centeredness, patient-centeredness, technology, and information systems, community care and reputation, HCO building, and communication. On the other hand, this review detected that BSC design modification to include external and managerial perspectives was necessary for many BSC implementations. Conclusion This review solves the KPI categorization dilemma. It also guides researchers and health care managers in choosing dimensions for future BSC implementations and performance evaluations in general. Consequently, dimension uniformity will improve the data sharing and comparability among studies. Additionally, despite the pandemic negatively influencing many dimensions, the researchers observed a lack of comprehensive HCO performance evaluations. In the same vein, although some resulting dimensions were assessed separately during the pandemic, other dimensions still lack investigation. Last, BSC dimensions may play an essential role in tackling the COVID-19 pandemic. However, further research is required to investigate the BSC implementation effect in mitigating the pandemic consequences on HCO.

The global trend of advanced aging comes at the cost of amplified onset of age-related diseases. Dementia is a common multifactorial age-related neurodegenerative disorder, which manifests with progressive declines in cognitive functioning and ability to perform activities of daily living. As polices discourage institutionalized care, family members act as primary caregivers and endure increased vulnerability to physical and mental health problems secondary to care-related changes in life routine and relationships. Targeting clinically significant distress at earlier stages through valid brief measures may promote caregivers’ wellbeing and dementia care continuity/quality. This study aimed to determine the optimal cutoff score of the Depression Anxiety Stress Scale 8-items (DASS-8) in a convenience sample of 571 European caregivers (Mean age = 53 ± 12 years, Italian = 74.4%, Swiss = 25.6%) through three methods. K-means clustering classified the sample into high- and low-distress clusters based on DASS-8 score of 19. Receiver operator curve (ROC) analysis using 48 and 7 cutoffs of the Zarit Burden Interview (ZBI) and the Three-Item University of California, Los Angeles, Loneliness Scale-version 3 (UCLALS3), revealed two DASS-8 cutoffs (12.5 and 14.5, area under the curve (AUC) = 0.85 and 0.92, p values < .001, 95% CI 0.82–0.88 and 0.89 to 0.94, sensitivity = 0.81 and 0.78, specificity = 0.76 and 0.89, Youden index = 0.57 and 0.67, respectively). Decision modeling produced two DASS-8 cutoffs (9.5 and 14.5) for predicting low and high caregiving burden and loneliness, respectively. According to the median of all DASS-8 cutoffs (14.5) the prevalence of mental distress was 50.8%. Distress correlated with key mental problems such as burnout and loneliness—in path analysis, DASS-8 scores were predicted by the ZBI, UCLALS3, care dependency, and receiving help with care, especially among older, female, and spouse caregivers. Further diagnostic workup should follow to confirm psycho-pathogenicity among caregivers with DASS-8 scores above 14.5. Investigations of the DASS-8 in other countries/populations may confirm the validity of this cutoff score.

Background The war on Gaza has taken a heavy emotional burden on Palestinians and has also affected many Jordanians who feel closely connected through ties and constant exposure to the conflict. Understanding these psychological effects helps highlight the true human cost of the conflict and the need for meaningful support. Objective This study aims to evaluate the psychological impact of the Gaza war on Palestinians and Jordanians and to examine the levels of trauma-related psychological distress and associated factors. Methods From October 2023 to April 2024, a descriptive cross-sectional survey was implemented utilizing a web-based questionnaire distributed over social media platforms. The survey comprised socio-demographic questions and the Arabic version of the Impact of Event Scale-Revised (IES-R). In total, 977 valid responses were included in the final analysis (87.9% Jordanians, 12.1% Palestinians). Results The mean IES-R score was 46.18 ± 9.89, indicating a severe psychological impact, with 75.3% of participants reporting significant distress (IES- R  ≥ 37). Palestinians reported a higher prevalence of severe distress (85.6%) while Jordanians reported a rate of 73.9%. Factors significantly associated with severe distress included female gender, residence in Palestine, a lack of prior exposure to war events, and the need for psychological support (all p  < 0.05). These findings illustrate the significant psychological toll of the conflict and highlight vulnerable subgroups requiring targeted mental health interventions. Conclusion The Gaza conflict has caused enormous psychological distress for both Jordanians and Palestinians. Women are affected more than men by war due to lack of prior exposure. People suffering from severe distress must have access to psychological support services and this raises the need for availability of mental health service in conflict-affected areas. Researchers who study long-term psychological impacts of war need to identify resilience indicators in order to develop the best possible support strategies.

Nurses constitute a significant portion of Jordan's healthcare workforce, and their competence plays a critical role in patient safety and quality of care. Global and national strategies highlight the importance of assessing and improving nursing competence. Despite the critical role of nurses, research on self-reported nursing competence (SRNC) in Jordan remains limited. This study explores self-reported nursing competence (SRNC) among registered nurses (RNs) in Jordan. A cross-sectional study was conducted with a sample of 212 RNs from public, private, and teaching hospitals. Data were collected using the short form of the Nursing Professional Competence (NPC) scale, a 35-item instrument scored on a 7-point Likert scale ranging from 1 (very low competence) to 7 (very high competence), with higher scores indicating greater perceived professional competence. The derived data was analyzed using SPSS software. The overall level of self-reported nursing competence was high, with a mean score of 76.69%. Among these six domains, the domain of \"documentation and administration of care\" scored the highest (78.26%), and \"care pedagogy\" scored the lowest (75.23%). The items that scored high included \"respectful communication,\" \"clinical follow-up,\" and \"documentation,\" which scored \"to a high degree.\" The items that scored lower included \"psychological needs,\" \"group-based education,\" and \"respect for different values,\" which scored \"to a fairly high degree.\".\". The Jordanian nursing community views itself as very competent; however, improvements are needed in particular fields. Continuous learning and training are required in order to retain and upgrade professional competency. The findings highlight the value of mentorship, a supportive work environment, and continuing education. Future research should include peer and supervisor evaluations to validate self-reported competence and better guide workforce development strategies.

Introduction: With the rise of multidrug-resistant healthcare-associated infections (HAIs) and the recent emergence of coronavirus disease 2019 (COVID-19), patient and family member engagement in infection control (IC) has gained increased attention. This study aimed to assess the level of education provided to patients and family members on IC measures in Hungary. Methodology: A cross-sectional study was conducted among 412 patients and family members from seven hospitals in Hungary during the COVID-19 pandemic. A previously developed questionnaire, based on the Centers for Disease Control and Prevention guidelines for isolation precautions, specifically the section on patient and family education, was used to assess education on several IC measures. Results: Of the 412 participants, 89.6% were patients, 59.2% were female, and 18.7% were experiencing their first hospital admission. The highest percentages of education were on respiratory hygiene (89.8%), HAIs (82.5%), and hand hygiene (82%). Regression analysis showed that counties were significant predictors of education on nearly all IC measures. Conclusions: This study reveals a high percentage of education on IC measures among patients and family members education in Hungary, in comparison to the existing literature. To sustain this high level of education, it is recommended that Hungarian health authorities incorporate IC patient and family education into the government regulations governing IC practices in hospitals. Additionally, hospitals should foster a more participatory environment for patients and family members in IC.

Background Limited research and studies prove the usefulness of case management for persons with disabilities, which helps disabled employees recover their dignity through medical vocational, and psychological rehabilitation in underdeveloped countries’ Return To Work (RTW) programs. Methods This qualitative case study design involved semi structured interviews with case managers as the primary data source, supplemented by secondary data from BPJS Ketenagakerjaan. Data analysis utilized QDA Miner Lite and Python with ArcGIS integration for descriptive visualization. Results The RTW program of BPJS Ketenagakerjaan has already adopted ILO’s fundamental suggestion, which creates two central themes: internal aspects that are essential to the RTW framework and external variables that impact RTW practice. The key themes produce six main pieces to discuss further: personal skill, personal literacy, providers, guidelines, authorities, and stakeholder support. Conclusion Return to Work Program benefits companies, and the implementation of a career development service or a partnership with non-governmental organizations guarantees that disabled employees who cannot return to work with their former employers are still in the global economy.