Objective: To determine the prevalence of secondary hyperparathyroidism among hemodialysis patients treated in three different centers. Methods: This is a descriptive study conducted by reviewing patient's medical records, Patients receiving hemodialysis therapy in three different centers: King Hussein Medical Center in Amman, Prince Hashem Hospital in Zarka, and Prince Ali Hospital in Karak, representing various governorate of Jordan. Patients included in the study were treated by hemodialysis for more than 6 months and have not had parathyroidectomy. We screened our patients for the purpose of the study during January 2014. Their laboratory values including serum creatinine, BUN, calcium, phosphorous, alkaline phosphatase and intact parathyroid hormone were recorded. Depending on the iPTH level, patients were divivded into three groups, adynamic bone disease group with iPTH levels less than 130pg/ml, euparathyroid group with iPTH within the target range for hemodialysis patients (130-210pg/ml), and secondary hyperparathyroidism group with iPTH more than 210pg/ml. Results: A total of 276 patients were included in this study. Males were 56.5% and females 43.5%, their age ranged from 23 to 87 years with duration of hemodialysis ranged from 6 to 300 months. Majority of patients (77.5%) found to have secondary hyperparathyroidism with an average intact parathyroid hormone level of 887.1pg/ml. The remaining patients showed either acceptable average intact parathyroid hormone level for the hemodialysis patients 127.7pg/ml (13.4%) or showed low average intact parathyroid level of 32.9pg/ml indicating the presence of the more serious adynamic bone disease (9.1%). Conclusion: Despite advancing hemodialysis treatment facilities and the use of calcium containing phosphorous binders and vitamin D analogue the incidence of secondary hyperparathyroidism remains high. This may represent late referral to nephrology care or may indicate poor patient compliance to the prescribed medications. Additional efforts should be implemented to enhance early referral of patients with chronic kidney disease to nephrology care.

The emergence of the COVID-19 virus highlighted the importance of public trust in official directives during a pandemic. As part of the measures taken to reduce the spread of the coronavirus, people were asked to maintain physical distancing. Compliance with physical distancing influenced by trust levels which are generally lower in minority groups. The current study aimed to explore the trust level and compliance with the physical distancing relationship among Arab minority and Jewish populations during three lockdowns during the COVID -19 outbreak in Israel. Three cross-sectional online surveys were conducted among a convenience sample of Jews and Arabs adults (≥18 years old) citizens of Israel following the first (April to June 2020), second (October to November 2020), and third lockdown (January to February 2021). The surveys collected demographic data, compliance with physical distancing, and trust level in official sources. In total, 613 (N = 281 Arab, N = 281 Jewish) participants completed the first online survey, 542 (N = 223 Arab, N = 319 Jewish) completed the second survey, and 98 (N = 38 Arab, N = 60 Jewish) completed the third survey. In the three surveys, both populations, Arabs and Jews, reported higher levels of trust in health professionals than in politicians. The level of trust and keeping physical distancing during the three lockdowns were significantly lower among Arab compared to the Jewish participants. However, the association between trust and social distancing was significant only in the first lockdown (OR = 2.02, 95% CI 1.37-2.97) but not in the second and third lockdowns. Trust in official directives is an important determinant of citizens' compliance with physical distancing guidelines during a pandemic. Minority groups have lower trust levels and face more challenges for keeping physical distancing. This should be brought to the policymakers' attention to increase trust and physical distancing among them. Key messages Understanding the relationship between trust and compliance and its potential consequences during a pandemic warrant particular attention in the present context of a global pandemic. It is of utmost importance to identify the unique characteristics of sub-populations and minority populations in which there may be additional factors affecting compliance.