Psychosocial and Sexual Aspects of Female Genital Circumcision in a Sample of Kurdish Women in the Kurdistan Region of Iraq.

BACKGROUND AND AIM: Female genital circumcision (FGC), a prevalent practice in the Kurdistan Region of Iraq, has significant psychosocial and sexual implications for affected women. Therefore, this study aimed to investigate these impacts among circumcised and non-circumcised Kurdish women. METHOD: This comparative study was conducted from January 2 to June 27, 2023, at the Al Mesalla for Human Rights Improvement organization in Erbil, Iraq. Purposive sampling was used to collect data using a comprehensive questionnaire. The questionnaire included demographic information, the Depression, Anxiety, and Stress Scale (DASS-21), the Rosenberg Self-Esteem Scale (RSE), and the New Sexual Satisfaction Scale-Short Form (NSSS-S). Statistical analysis was performed using SPSS version 26 (IBM Corp., Armonk, NY), with frequency and percentage used for categorical variables and mean and standard deviation for quantitative variables. Independent sample t-tests and Chi-square tests were conducted to compare groups. A p-value of less than 0.05 was considered statistically significant. RESULTS: A total of 772 participants were enrolled in the study, including 382 circumcised and 390 non-circumcised women. The study found significant differences between the two groups in terms of depression, self-esteem, and sexual satisfaction. Circumcised women had higher mean scores for depression (12.19 ± 5.6 vs. 10.68 ± 5.3), lower mean scores for self-esteem (24.4 ± 12.1 vs. 30.3 ± 10.1), and lower mean scores for sexual satisfaction (52.4 ± 24.6 vs. 67.6 ± 20.4) compared to non-circumcised women (all p < 0.001). CONCLUSIONS: The study demonstrated that FGC is associated with higher levels of depression, lower self-esteem, and lower sexual satisfaction among Kurdish women. It is recommended for policymakers and healthcare providers to develop targeted interventions to address the psychosocial and sexual health needs of circumcised women in the Kurdistan Region of Iraq.

Assessment of Anxiety, Stress, and Depression Among COVID-19 Survivors After 40 Months in the Kurdistan Region of Iraq: An Online Cross-Sectional Study.

BACKGROUND AND AIMS: COVID-19 survivors often experience significant and pervasive psychological distress. This study aimed to investigate the prevalence and demographic factors affecting anxiety, stress, and depression levels among COVID-19 survivors in the Kurdistan region of Iraq. METHOD: This online cross-sectional study was conducted from August 1, 2023 to December 17, 2023, in the Kurdistan region of Iraq, including Erbil, Sulaymaniyah, and Duhok. Purposive sampling was used to collect data using an online survey. The survey included demographic information and the Depression, Anxiety, and Stress Scale - 21 Items (DASS-21). Statistical analysis was performed using Stata version 12 (StataCorp LLC, College Station, TX), with frequency and percentage used for categorical variables and mean and standard deviation for quantitative variables. Ordinal regression analyses were conducted to assess associations between demographic factors and mental health outcomes. A p-value of less than 0.05 was considered statistically significant. RESULTS: A total of 783 participants were enrolled in the study. The mean score for anxiety was 11.62 ± 4.71, indicating moderate levels. For depression, the mean score was 11.54 ± 5.21, indicating mild levels, and for stress, the mean score was 14.0 ± 5.78, indicating normal levels. Younger individuals (15-27) showed higher stress (Estimate: 18.96, P=0.001) and anxiety (Estimate: 2.79, P=0.001) levels compared to older age groups. Males reported significantly lower stress (Estimate: -1.01, P=0.001), anxiety (Estimate: -1.29, P=0.001), and depression (Estimate: -0.72, P=0.001) than females. Participants with a diploma had lower anxiety (Estimate: 0.65, P=0.004) and stress (Estimate: 0.77, P=0.002) levels compared to those with only elementary education. CONCLUSIONS: The study found moderate levels of anxiety among COVID-19 survivors, with mild depression and normal stress levels. To address these issues, it is recommended that policymakers develop targeted mental health interventions. Healthcare providers should focus on early identification and treatment, providing personalized counseling and support to enhance coping mechanisms and overall psychological well-being. By implementing these measures, mental health outcomes for COVID-19 survivors in Iraq can be significantly improved.

Assessment of Knowledge and Practice Regarding Psychological First Aid Among Secondary School Students in Erbil City.

BACKGROUND AND AIM: Secondary school students in Erbil City face various stressors and challenges that may impact their mental well-being. This study aimed to assess the knowledge and practical application of psychological first aid (PFA) among these students. METHOD: This cross-sectional study was conducted from June 10th to June 25th, 2024, in six high schools in Erbil City, Iraq. Participants were selected using a purposive sampling method. Data were collected using two self-structured questionnaires, which included demographic information, a knowledge assessment, and a practical application assessment of PFA. Statistical analysis was performed using SPSS version 28 (IBM Corp., Armonk, NY). Frequency and percentage were used for categorical variables, and mean and standard deviation for quantitative variables. Ordinal regression analyses were conducted to assess the relationships between demographic variables and PFA knowledge and practice. Spearman correlation was used to determine the relationship between knowledge and practice. A p-value of less than 0.05 was considered statistically significant. RESULTS: A total of 412 students were enrolled in the study. The mean scores for knowledge and practice indicated fair levels, with mean scores of 7.66 ± 1.34 for knowledge and 7.01 ± 1.38 for practice. The analysis showed that 11 students (2.7%) had poor knowledge, 161 students (39.1%) had fair knowledge, and 240 students (58.2%) had good knowledge of PFA. In terms of practice, 15 students (3.6%) exhibited poor practice, 237 students (57.6%) demonstrated fair practice, and 160 students (38.8%) showed good practice of PFA. Significant associations were found between several demographic variables and PFA knowledge and practice. Males had higher knowledge scores (estimate = 1.22, 95% CI: 0.20, 2.24, P = 0.02), as did students from families with insufficient monthly income (estimate = 0.91, 95% CI: 0.10, 1.72, P = 0.03) and those residing in urban areas (estimate = 0.83, 95% CI: 0.17, 1.50, P = 0.01). For practice, the occupation of the father was significant, with unemployed fathers associated with lower practice scores (estimate = -1.08, 95% CI: -2.06, -0.09, P = 0.03). CONCLUSIONS: The study showed that students had fair knowledge and practice of PFA. To improve these scores, it is recommended that nurses and educators develop targeted interventions and training programs. These should focus on enhancing students' understanding and practical skills in PFA, ensuring they are better equipped to handle psychological distress among their peers.

The Increased Frequency of Type 1 Regulatory T (Tr1) Cells and the Altered Expression of Aryl Hydrocarbon Receptor (AHR) and Interferon Regulatory Factor-4 (IRF4) Genes in Type 1 Diabetes: A Case-Control Study.

Background and aim Type 1 diabetes is an autoimmune disorder characterized by the destruction of pancreatic beta cells, leading to insulin deficiency and hyperglycemia. Regulatory T cells (Tregs), particularly type 1 regulatory T (Tr1) cells, play a crucial role in modulating autoimmune responses. Therefore, this study aimed to evaluate the frequency of Tr1 cells and their association with aryl hydrocarbon receptor (AHR) and interferon regulatory factor-4 (IRF4) gene expression levels in type 1 diabetes mellitus (T1DM) compared to the healthy controls. Method A case-control study design was used. The case group included patients diagnosed with T1DM, while the control group consisted of healthy individuals, matched for age and sex. Blood samples were collected, and peripheral blood mononuclear cells (PBMCs) were isolated. Serum interleukin 10 (IL-10) and interleukin 21 (IL-21) levels were measured using enzyme-linked immunosorbent assay (ELISA). The gene expression of AHR and IRF4 was analyzed using quantitative real-time polymerase chain reaction (qPCR), and Tr1 cell populations were determined using flow cytometry. Data were summarized with mean and standard error of the mean (SEM) for quantitative variables. Independent sample t-test, chi-square test, and the Mann-Whitney U test were used to compare groups. Statistical analyses were performed using SPSS version 25 (IBM SPSS Statistics, Armonk, NY), with significance levels set at p < 0.05. Figures were created using GraphPad Prism (GraphPad Software, San Diego, CA). Results A total of 45 cases were enrolled in the study, with 30 T1DM patients and 15 healthy controls. The mean IL-10 concentration was significantly higher in the patients (10.4 ± 1.1 pg/mL) compared to the healthy controls (5.1 ± 0.7 pg/mL), with a p-value of 0.001. There was no significant difference in IL-21 levels between the patients (76.1 ± 9.0 pg/mL) and healthy controls (88.2 ± 17.5 pg/mL), indicated by a p-value of 0.480. AHR gene expression was significantly lower in patients, with a p-value of 0.037. Although IRF4 gene expression was higher in patients, the difference was not statistically significant (p = 0.449). Tr1 cell frequency was significantly higher in T1DM patients (1.45% of cluster of differentiation 4+ {CD4+} T cells) compared to the healthy controls (0.40% of CD4+ T cells), with a p-value of 0.045. Conclusions The study demonstrated that T1DM is associated with higher IL-10 levels, decreased AHR gene expression, and a higher frequency of Tr1 cells. Policymakers should focus on developing targeted immunomodulatory therapies to address these immunological abnormalities. Healthcare providers should prioritize monitoring cytokine levels and gene expression in T1DM patients to tailor treatment plans effectively. Further research is needed to explore the therapeutic potential of modulating Tr1 cells and their related pathways in T1DM management.

The relationship between internet addiction, sleep quality, and psycho-social problems among secondary school students in Erbil, 2023-2024.

OBJECTIVE: This study aimed to show the association between internet addiction (IA), sleep quality, and psycho-social problems among secondary school students DESIGN: A cross-sectional, descriptive, and correlational study design was used. SAMPLE: A total of 557 students from four secondary schools in Erbil were selected using multistage cluster sampling MEASUREMENTS: The questionnaires of this research contained socio-demographic data, Internet Addiction Test (IAT), Pittsburgh Sleep Quality Index (PSQI), and Pediatric Symptom Checklist-Y (PSC-Y) questionnaire. RESULTS: Findings indicated that students displayed a mild IA, averaging a score of 42.9 ± 19.18. Furthermore, the average sleep quality (PSQI) score was 8.95 ± 2.75, indicating moderate sleep disturbance, and the average score for psycho-social problems was 27.78 ± 13.29. Importantly, there was a strong and positive association between IA and psycho-social issues, as shown by a correlation coefficient of 0.31 (p < .001). Sleep quality was correlated with IA and psychosocial issues (p < .001, correlation values: .23 and .27, respectively) CONCLUSIONS: The study highlights the urgent need for health policymakers and nursing managers in Erbil to develop targeted interventions, such as awareness campaigns and digital well-being programs in school curricula, to mitigate the interlinked issues of IA, sleep quality, and psycho-social problems among students.

Exploring Young Adults' Reluctance to Engage With Psychiatric Hospitals in Erbil, Iraq: Identifying Barriers to Psychiatric Care.

BACKGROUND AND AIM: In Erbil, Iraq, the reluctance of young adults to engage with psychiatric services is influenced by a complex array of barriers, including stigma-related, attitudinal, and instrumental factors that hinder effective mental healthcare access. This study aimed to identify these specific barriers to accessing psychiatric care among young adults in Erbil. MATERIALS AND METHODS: The study utilized a cross-sectional online survey conducted between April 5th and May 1st, 2024. Data collection was carried out through purposive sampling and involved a comprehensive questionnaire. Electronic informed consent was obtained from all participants before they started the survey, which collected demographic data and utilized the Barriers to Access to Care Evaluation (BACE v3) tool. Statistical analysis was conducted using SPSS version 27 (IBM Corp., Armonk, NY). Descriptive statistics (frequency and percentage) were used for categorical data, while the mean and standard deviation characterized continuous variables. Chi-square tests, including Fisher's exact test and odds ratio (OR), were used to analyze categorical data, with a significance level set at p < 0.05. RESULTS: A total of 407 participants were enrolled in the study. The study highlighted several barriers to mental health care. Stigma-related barriers were significant, with participants fearing being seen as weak (mean score = 2.14, SD = 0.96) and concerns about being labeled "crazy" (mean score = 1.80, SD = 1.19). Regarding attitudinal barriers, there was a notable preference for dealing with issues independently (mean score = 2.04, SD = 0.98) and a tendency toward resolving problems without professional help (mean score = 1.88, SD = 0.98). Additionally, instrumental barriers were identified, including the rare availability of culturally diverse mental health professionals (mean score = 1.78, SD = 1.09) and practical difficulties such as arranging transportation to appointments (mean score = 0.61, SD = 0.87). CONCLUSION: The study demonstrated that young adults in Erbil face significant stigma and attitudinal and instrumental barriers to accessing psychiatric care. In response to these findings, it is recommended for the government to prioritize mental health awareness, actively destigmatize mental health issues, and improve service accessibility to foster a supportive care environment. Additionally, mental health professionals and educational institutions should collaborate to provide targeted support programs and resources for young adults.

Clustered Regularly Interspaced Short Palindromic Repeat-1 (CRISPR-1) Locus as a Tool for Tracing the Zoonotic History of Salmonella enterica Strains.

Background Salmonella enterica is a significant foodborne pathogen that causes considerable illness and death in humans and animals. The clustered regularly interspaced short palindromic repeat (CRISPR)-CRISPR-associated protein (Cas) system in bacteria acts as an adaptive immune defense against invasive genetic elements by incorporating short intergenic spacers (IGSs) into CRISPR loci. These loci serve as molecular records of past interactions with phages and plasmids, providing insights into the transmission and evolution of bacterial strains across different hosts. Aim This study aimed to investigate the diversity of IGSs in the CRISPR-1 locus of S. enterica isolates from humans and camels. The objective was to assess the potential of IGSs to distinguish strains, track sources, and understand patterns of zoonotic transmission. Materials and methods Genomic DNA was extracted from multiple strains of S. enterica, and the CRISPR-1 locus was polymerase chain reaction (PCR) amplified and sequenced. The sequences were compared to identify distinct patterns of IGSs and potential host-specific characteristics. Sanger sequencing and bioinformatics tools were used to classify the IGSs and determine their similarity to known sequences in the National Center for Biotechnology Information (NCBI) database. Results Sequence analysis revealed five distinct CRISPR-1 types among S. enterica isolates from humans and three among camel isolates. The presence of shared IGSs between human and camel S. enterica isolates suggested zoonotic or reverse-zoonotic transmission events. Additionally, host-specific unknown IGSs (UIGS) were identified. Importantly, camel isolates initially identified as S. enterica subspecies enterica serovar Enteritidis based on rrnH gene sequencing were reclassified as S. enterica serovar Enteritidis based on CRISPR-1 profiling, demonstrating the higher resolution of CRISPR-based genotyping. Conclusion The diversity of IGSs in the CRISPR-1 locus effectively differentiated S. enterica strains and provided insights into their evolutionary origins and transmission dynamics. CRISPR-based genotyping proves to be a promising tool to complement traditional serotyping methods, enhancing the molecular epidemiology of salmonellosis and potentially leading to better management and control strategies for this pathogen.