The early impact of the global lockdown on post-secondary students and staff: A global, descriptive study.

OBJECTIVES: The aim of this study was to gain a preliminary, broad-level understanding of how the first lockdown impacted post-secondary students, faculty, and staff worldwide. METHODS: The data were obtained via a global online cross-sectional questionnaire survey using a mixed-method design and disseminated to university students, faculty, and staff from April to November 2020. The data were categorized in four themes/categories: (1) social life and relationships, (2) access to services, (3) health experiences, and (4) impact on mental health well-being. RESULTS: The survey included 27,804 participants from 121 countries and 6 continents. The majority of participants were from Europe (73.6%), female (59.2%), under 30 years of age (64.0%), living in large urban areas (61.3%), %), and from middle-income families (66.7%). Approximately 28.4% of respondents reported that the lockdown negatively impacted their social life, while 21.2% reported the lockdown had a positive impact. A total of 39.2% reported having issues accessing products or services, including essentials, such as groceries, or medical services. In addition, respondents reported an increase in stress and anxiety levels and a decrease in quality of life during the first 2 weeks of the lockdown. CONCLUSIONS: The COVID-19 pandemic and lockdown measures had an evident impact on the lives of post-secondary students, faculty, and staff. Further research is required to inform and improve policies to support these populations at both institutional and national levels.

Perspectives of older Tamil immigrants on social inclusion: A concept mapping study in Canada.

Evidence shows that immigrants face several challenges post migration, impacting their social inclusion. Yet, limited scholarly knowledge exists on older immigrants including Tamils from Sri Lanka. Thus, an exploratory concept mapping (CM) study was conducted in 2017 with 27 Tamil immigrant women and men aged ≥55 years and settled in Toronto, Canada. The aim was to gather their perspectives on factors that help them to feel socially included (focal question). The CM methodology first engaged participants in brainstorming sessions to generate ideas in response to the focal question. Participants then joined sorting and rating sessions and sorted 72 generated items and rated them on a scale of 1-5 for importance and feasibility to initiate a change. Finally, in the interpretation session, participants provided feedback on the visual cluster maps generated through quantitative analysis of the collected data. Participants labelled the seven identified clusters: (a) Services for Employment and Settlement; (b) Financial Independence; (c) Medical System and Senior Care; (d) Adaptation and Integration; (e) Family Harmony; (f) Cultural Interaction and Feeling of Security; and (g) Social Interaction. The clusters one to three were at the top for importance (mean 4.33, 4.22, 4.17) and participants interpreted these as needing policy-level attention (e.g. credential evaluation, hiring practices) and identified the roles of advocacy and community-engagement for community-based programmes (CBPs). The Family Harmony was interpreted as needing 'work within families', while CBPs' culturally sensitive outreach was viewed as valuable. Participant interpretation of other clusters highlighted the role of social networking, trust, belonging, civic engagement and social cohesion through joint working of the community members and CBPs. The findings call for an inter-sectoral and community-engaged approach to strengthen the social inclusion of the community. Future research with a larger sample is needed, especially on early settlement experiences and social inclusion of older immigrants.

Depression-level symptoms among Syrian refugees: findings from a Canadian longitudinal study.

BACKGROUND: Canada launched the Syrian Refugee Resettlement Initiative in 2015 and resettled over 40,000 refugees. AIM: To evaluate the prevalence of depression-level symptoms at baseline and one year post-resettlement and analyze its predictors. METHODS: Data come from the Syrian Refugee Integration and Long-term Health Outcomes in Canada study (SyRIA.lth) involving 1924 Syrian refugees recruited through a variety of community-based strategies. Data were collected using structured interviews in 2017 and 2018. Depression symptoms were measured using Patient Health Questionnaire 9 (PHQ-9). Analysis for associated factors was executed using multinomial logistic regression. RESULTS: Mean age was 38.5 years (SD 13.8). Sample included 49% males and 51% females settled in Ontario (48%), Quebec (36%) and British Columbia (16%). Over 74% always needed an interpreter, and only 23% were in employment. Prevalence of depression-level symptoms was 15% at baseline and 18% in year-2 (p < 0.001). Significant predictors of depression-level symptoms at year-2 were baseline depression, sponsorship program, province, poor language skills, lack of satisfaction with housing conditions and with health services, lower perceived control, lower perceived social support and longer stay in Canada. CONCLUSION: Increase in depression-level symptoms deserves attention through focusing on identified predictors particularly baseline depression scores, social support, perceived control and language ability.

An Eight-Week, Web-Based Mindfulness Virtual Community Intervention for Students' Mental Health: Randomized Controlled Trial.

BACKGROUND: Innovative interventions are needed to address the increasing mental health needs of university students. Given the demonstrated anxiolytic and antidepressant benefits of mindfulness training, we developed an 8-week, Web-based Mindfulness Virtual Community (MVC) intervention informed by cognitive behavioral therapy (CBT) constructs. OBJECTIVE: This study investigated the efficacy of the MVC intervention in reducing symptoms of depression, anxiety, and stress among undergraduate students in Toronto, Canada. The secondary outcomes included quality of life, life satisfaction, and mindfulness. METHODS: The first 4 weeks of the full MVC intervention (F-MVC) comprised: (1) 12 video-based modules with psycho-education on students' preidentified stressful topics and topically applied mindfulness practice; (2) anonymous peer-to-peer discussion forums; and (3) anonymous, group-based, professionally guided, 20-min live videoconferences. The second 4 weeks of F-MVC involved access only to video-based modules. The 8-week partial MVC (P-MVC) comprised 12 video-based modules. A randomized controlled trial was conducted with 4 parallel arms: F-MVC, P-MVC, waitlist control (WLC), and group-based face-to-face CBT; results for the latter group are presented elsewhere. Students recruited through multiple strategies consented and were randomized: WLC=40; F-MVC=40, P-MVC=39; all learned about allocation after consenting. The online surveys at baseline (T1), 4 weeks (T2), and 8 weeks (T3) included the Patient Health Questionnaire-9 item, Beck Anxiety Inventory, Perceived Stress Scale, Quality of Life Scale, Brief Multi-Dimensional Students Life Satisfaction Scale, and Five-Facet Mindfulness Questionnaire. Analyses employed generalized estimation equation methods with AR(1) covariance structures and were adjusted for possible confounders (gender, age, birth country, paid work, unpaid work, physical activities, self-rated health, and mental health counseling access). RESULTS: Of the 113 students who provided T1 data, 28 were males and 85 were females with a mean age of 24.8 years. Participants in F-MVC (n=39), P-MVC (n=35), and WLC (n=39) groups were similar in sociodemographic characteristics at T1. At T3 follow-up, per adjusted comparisons, there were statistically significant reductions in depression scores for F-MVC (score change -4.03; P<.001) and P-MVC (score change -4.82; P<.001) when compared with WLC. At T3, there was a statistically significant reduction in anxiety scores only for P-MVC (score change -7.35; P=.01) when compared with WLC. There was a statistically significant reduction in scores for perceived stress for both F-MVC (score change -5.32; P<.001) and P-MVC (score change -5.61; P=.005) compared with WLC. There were statistically significant changes at T3 for quality of life and mindfulness for F-MVC and P-MVC vs WLC but not for life satisfaction. CONCLUSIONS: Internet-based mindfulness CBT-based interventions, such as F-MVC and P-MVC, can result in significant reductions in symptoms of depression, anxiety, and stress in a student population. Future research with a larger sample from multiple universities would more precisely test generalizability. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number ISRCTN92827275; https://www.isrctn.com/ISRCTN92827275.

Posttraumatic Stress Disorder, Social Support and Coping Among Afghan Refugees in Canada.

Posttraumatic-stress-disorder (PTSD) is one of the common mental health conditions among Afghan refugees resettled in developed countries. The current study explores how social support, coping and other factors correlate with PTSD in this population. A survey was conducted with 49 adult Afghan refugees (males 41%, female 59%) who completed Harvard Trauma Questionnaire during their visit to a Community Health Centre in Toronto. Bivariate analysis and structural-equation-modeling (SEM) were used to examine associations and pathways between PTSD and other variables. Mean PTSD score was 2.53 (SD 0.92) with 53% showing symptoms of PTSD which was significantly associated with age, unemployment, social support and self-rated health. SEM showed that higher social support scores were significantly associated with lower PTSD scores, and the effect of coping and English language were mediated through social support. The high prevalence of PTSD, its association with social support and self-rated health are important issues to be considered for refugee resettlement programs.

Perceived impact of contextual determinants on depression, anxiety and stress: a survey with university students.

BACKGROUND: Young adults starting college or university education encounter multiple stressors related to transitional life-stage and novel environments. Current studies reveal high rates of symptoms related to common mental health problems like depression, anxiety and stress. However, limited knowledge exists on the determinants on these problems among Canadian students. The primary aim of the study was to investigate the impact of contextual determinants, as perceived by students, on self-reported mental health, and how these impacts varied by depression, anxiety and stress. METHODS: A cross-sectional survey was conducted with students attending a large university in Toronto, Canada. Participants completed a self-administered online questionnaire as part of a larger project. The questions asked about contextual determinants related to personal, interpersonal, family, social, socio-economic and political factors along with levels of depression, anxiety and stress as measured by Patient Health Questionnaire-9, Beck Anxiety Inventory and Perceived Stress Scale. RESULTS: A total of 148 students completed the questionnaire (37 males and 111 females) with an age range of 19-54 years (median 22, IQR 21-24.8). English was reported as first language by 62.8% while 34.5% self-identified as white and 58.1% reported being born in Canada. Overall, 39.5% reported symptoms of moderate to severe depression, 23.8% reported moderate-severe anxiety and 80.3% reported moderate-severe levels of perceived stress, with no significant differences between males and females. In the final multivariate analysis, variables significantly associated with depression were grade-point-average (aOR 2.46, 95% CI 1.017-5.97), family factors (aOR 3.46, 95% CI 1.50-7.94), social factors (aOR 3.24, 1.30-8.1), self-rated health (aOR 0.34, 95% CI 0.14-0.82) and political factors (aOR 0.40, 95% CI 0.16-0.97). Anxiety was significantly associated with family factors (aOR 2.79, 1.09-7.18), socioeconomic factors (aOR 2.59, 95% CI 1.05-6.42) and age (aOR 0.33, 95% CI 0.11-0.98). The significant factors for stress were grade-point-average (aOR 2.41, 1.01-5.75) and social factors (aOR 3.87, 95% CI 1.59-9.43). CONCLUSION: The study found strong to moderate impact of several determinants on depression, anxiety and stress. The results suggest a need to address a variety of factors affecting students' mental health.Trial registration Parent trial: http://www.isrctn.com/ISRCTN92827275.

Waterpipe Smoking among University Students in Sulaimaniyah, Iraqi Kurdistan: Prevalence, Attitudes, and Associated Factors.

BACKGROUND: Waterpipe smoking is increasingly becoming the most common method of tobacco use among adolescents in the Eastern Mediterranean Region. This study was undertaken in Iraqi Kurdistan to estimate its prevalence among students and investigate attitudes and factors associated with it. MATERIALS AND METHODS: In a cross-sectional survey at Sulaimani Polytechnic University, 1160 students were approached in a two-stage design using a self-administered questionnaire. Data was entered into Epidata and analysis was done in Stata. RESULTS: Prevalence of cigarette smoking was 10% and waterpipe smoking was 28% (male 49%, female 10%). Waterpipe smoking was initiated prior to joining the university in 74% of the cases and 22% of waterpipe smokers smoked every day. The most common place for smoking was coffee shops (52%) and 71% of smokers shared the pipe. The significant risk factors were smoking cigarettes (OR 10.3, 95% CI 7.0-15.0), male gender (OR 5.7, 95% CI 3.9-8.2), non-Kurdish ethnicity (OR 3.0, 95% CI 1.6-15.9), city residence (OR 1.5, 95% CI 1.0-2.1), and use of alcohol and other substances (OR 2.8 95% CI 1.4-5.6). CONCLUSION: Waterpipe smoking is highly prevalent among students in Iraqi Kurdistan, especially among males, and is becoming a public health problem. Tobacco control interventions should be designed specifically to address this problem among adolescents and the youth.

Tuberculosis in Sulaimaniyah, Iraqi Kurdistan: A Detailed Analysis of Cases Registered in Treatment Centers.

BACKGROUND: Tuberculosis (TB) remains a major public health problem especially in low and middle-income countries. The current study was undertaken to estimate the incidence of the disease and describe its epidemiological characteristics in Iraqi Kurdistan. MATERIALS AND METHODS: A retrospective study was carried out on cases registered in the directly observed treatment-short course (DOTS) centers in Sulaimaniyah province. Information was collected from the summary reports of all cases registered in 2010 and detailed information was obtained from 307 cases in the main center. RESULTS: During 2010, a total of 530 new and relapsed cases were registered in the DOTS centers amounting to an annual incidence of 31 per 100,000. Over 73% of cases were pulmonary TB and 45% of all cases had positive smear. Most common symptoms were cough (58%), sweating (49%) and fever (48). Almost 43% of patients were diagnosed by direct swab examination, 30% by biopsy and 23% through clinical and radiologic examination. In relation to outcome, 89% of patients were treated successfully, 7% died and 3% defaulted. Mortality rate was 8% in pulmonary infection and 4% in extrapulmonary infection. Old age (65 years and over) was significantly associated with higher odds of death compared to people aged 34 years and younger (OR 6.7, 95% CI 1.3-36.1, P=0.03). CONCLUSION: The incidence of TB is still high in the Iraqi Kurdistan. The DOTS has been successful in treating the majority of cases but there are areas needing improvement especially record-keeping and patient follow-up during and after treatment.

Childhood burns in Sulaimaniyah province, Iraqi Kurdistan: a prospective study of admissions and outpatients.

BACKGROUND: While it is globally observed that young children are at a higher risk of burn injuries, little is known about childhood burns in Iraqi Kurdistan. This study was undertaken to describe the epidemiology of burns amongst pre-school children in this region. METHODS: A prospective study was undertaken from November 2007 to November 2008 involving all children aged 0-5 years attending the burns centre in Sulaimaniyah province for a new burn injury whether treated as an outpatient or admitted to hospital. RESULTS: 1,122 children attended the burns centre of whom 944 (84%) were interviewed (male 53%, female 47%). Mean age was 1.9 years with children aged 1 year comprising 32% and those aged 2 years comprising 21% of the sample. The incidence of burns was 1044/100,000 person-years (1030 in females and 1057 in males). Mechanisms of injury included scalds (80%), contact burns (12%) flames (6%) and other mechanisms (2%). Almost 97% of burns occurred at home including 43% in the kitchen. Winter was the commonest season (36%) followed by autumn (24%). There were 3 peak times of injury during the day corresponding to meal times. The majority of burns were caused by hot water (44%) and tea (20%) and the most common equipment/products responsible were tea utensils (41%). There were 237 admissions with an admission rate of 95 per 100,000 person-years. Scald injuries accounted for most admissions (84%). Median total body surface area affected by the burn or scald (TBSA) was 11% and median hospital stay was 7 days. In-hospital mortality was 8%. Mortality rate was 4% when TBSA was ≤25%, and 100% when TBSA was over 50%. CONCLUSION: Burn incidence is high in young children especially those aged 1-2 years. Preventive interventions targeted at families with young children & focusing on home safety measures could be effective in reducing childhood burns.

Female genital mutilation in Iraqi Kurdistan: description and associated factors.

The high prevalence of female genital mutilation has been a concern in Iraqi Kurdistan. This study was undertaken to estimate its prevalence and describe factors associated with its occurrence. A cross-sectional survey was undertaken from March to April 2011 of females aged up to 20 years using interviews and clinical examination. The survey included 1,508 participants with mean age of 13.5 years (SD 5.6). Overall female genital mutilation prevalence was 23%, and the mean age at which it had been performed was 4.6 years (SD 2.4). Type I (partial or total removal of the clitoris) comprised 76% of those who had had female genital mutilation; in 79% of cases the decision to perform it was made by the mother; and in 54% of cases it was performed by traditional birth attendants/midwives. Women aged 16 years and over were more likely to have had female genital mutilation compared to children aged below 6 years (OR 11.9, p < .001). Children of uneducated mothers were eight times as likely to have had genital mutilation compared to children of mothers with over nine years of education (OR 8.0, p < .001). Among women aged 17 years and younger, 34% of those who were married had been circumcised versus 17% of those who were not married (p < .001). Participants residing in the northeast of Kurdistan region were more likely to have been circumcised. The study results show that female genital mutilation is a frequent practice in Iraqi Kurdistan. Attention and intervention is needed to address this aspect of the well-being of girls and women.

Risk factors for burns at home in Kurdish preschool children: a case-control study.

BACKGROUND: It is globally reported that young children are at a higher risk of burns but little is known about the individual risk factors. This study was undertaken in 2008 to investigate factors associated with burn injuries in children aged 0-5 years. METHODS: This was a case-control study with cases recruited prospectively from children attending hospital for a new burn injury and controls recruited from children admitted for other conditions. RESULTS: A total of 248 cases and 248 controls were recruited. Cases included scalds (79%), contact burns (17%) and flame injuries (4%). Burns were most commonly caused by tea utensils (42%) and kerosene stoves (36%). Multivariable analyses found that a poor living standard (OR 5.4, 95% CI 2.6 to 11.7), having a child with a higher activity score (OR 5.3, 95% CI 3.4 to 8.5), having a history of burns in other family members (OR 2.8, 95% CI 1.5 to 5.2) and a higher number of home hazards (OR for a one unit increase in hazards score 1.32, 95% CI 1.02 to 1.70) were all associated with a significant increase in the odds of a burn injury. The presence of a second carer (OR 0.42, 95% CI 0.2 to 0.7) and having disability (OR 0.14, 95% CI 0.03 to 0.6) were protective factors. CONCLUSIONS: This information about risk factors for burn injuries can be used to target preventive interventions towards families at the greatest risk of injury.

Antibiotic susceptibility of vancomyin and nitrofurantoin in Staphylococcus aureus isolated from burnt patients in Sulaimaniyah, Iraqi Kurdistan.

Burns remain a significant public health problem in terms of morbidity and mortality throughout the world, especially in low and middle-income countries. Burning raptures the skin barriers that normally prevent invasion by microorganisms and infection is a major complication in burn patients. Methicillin resistant Staphylococcus aureus (MRSA) is the most important nosocomial pathogen. This retrospective analysis was conducted in the burn unit of the Department of Microbiology in the Sulamaini Plastic Surgery and Burns Hospital. The analysis is based on data collected from the medical records of 2938 burn patients, hospitalized between May 2008 and December 2011. The clinical samples were taken from various body sources for microbiological tests. Patients with a high percentage of total body surface area burnt (P<0.001) and a longer hospital stay (P<0.001) were more likely to have infection compared to other patients. In addition, among all tested antibiotics, vancomycin and nitrofurantion seem to be the most effective antibiotics for MR- SA. Furthermore there was a significant association between age and antibiotic resistance for all antibiotics except for vancomycin and nitrofurantoin. Resistance to antibiotics increased with advancing age. The wide use of antibiotics in the treatment of bacterial infections has probably led to the emergence and spread of resistant strains. Routine microbiological surveillance and careful in vitro testing prior to antibiotic use and strict adherence to hospital antibiotic policy may help in the prevention and treatment of antibiotic resistant pathogens in burn infections.

Suicide by self-burning in Iraqi Kurdistan: description and risk factors.

This study aims to provide evidence for the problem of suicide by self-burning in Iraqi Kurdistan. Data were collected prospectively from all patients admitted to the burn center in the province of Sulaymaniyah and cases of self-burning were compared with cases of accidental burns. There were 197 cases with an annual incidence rate of 8.4 per 100,000 per year and female to male risk ratio of 13.1. Independent risk factors for self-burning were female sex (odds ratio 13.75, 95% CI 6.91-27.36, P < 0.001); young age of 11 to 18 years (OR 3.92, 95% CI 2.20-7.0, P < 0.001); poor education (OR 2.50, 95% CI 1.15-5.45, P = 0.02); spring season (OR 2.39, 95% CI 1.3-4.41, P = 0.005); and small family size (OR 2.72, 95% CI 1.44-5.15, P = 0.002). Suicide by self-burning is common in Iraqi Kurdistan especially among women. Urgent action is required to provide a better understanding of the situation, and identify partners, capacities, and opportunities for action.

Burns in Sulaymaniyah province, Iraq: epidemiology and risk factors for death in patients admitted to hospital.

This retrospective study was undertaken to describe the epidemiology of burns in the province of Sulaymaniyah in Iraqi Kurdistan and investigate factors associated with mortality. Hospital records of all patients admitted to the Burns and Plastic Surgery Centre of Sulaymaniyah for a burn incident during the calendar year of 2006 were reviewed retrospectively. A total of 947 acute burn patients were admitted over the year (females 53.5%, males 46.5%) of whom 41% were aged 0 to 14 years. Flame injuries were responsible for 59% and scalds for 37% of injuries. The median TBSA burnt was 19%, the median length of hospital stay was 5 days, and in-hospital mortality rate was 28%. Multivariable logistic regression showed that burn size, inhalation injury, older age, and female sex were significant risk factors for death. The adjusted odds ratios were 4.8 (95% confidence interval [CI] 1.3-20.0) for those aged 60 years or older compared with children aged 0 to 5 years; 2.2 (95% CI 1.2-4.1) for females compared with males; 9.8 (95% CI 4.8-20.0) for presence of inhalation injury; and 112.8 (95% CI 57.4-221.4) for ≥ 40% TBSA burnt compared with < 40% TBSA burnt. Burn injuries are an important public health problem in Iraq, and further studies are required to investigate circumstances surrounding burns and risk factors to inform planning of prevention programs.

Epidemiology of burn injuries in the East Mediterranean Region: a systematic review.

BACKGROUND: Burn injuries remain one of the leading causes of injury morbidity and mortality in the World Health Organization's East Mediterranean Region. To provide an overview on the epidemiology of burn injuries in this region, a systematic review was undertaken. METHODS: Medline, Embase and CINAHL were searched for publications on burns in this region published between 01/01/1997 and 16/4/2007. Data were extracted to a standard spreadsheet and synthesised using a narrative synthesis. No attempt has been made to quantitatively synthesise the data due to the large degree of clinical heterogeneity between study populations. RESULTS: Seventy one studies were included in the review, from 12 countries. Burn injuries were found to be one of the leading causes of injury morbidity and mortality. The reported incidence of burns ranged from 112 to 518 per 100,000 per year. Burn victims were more frequently young and approximately one third of the victims were children aged 0-5 years. Hospital mortality ranged from 5 to 37%, but was commonly above 20%. Intentional self-harm burns particularly involving women were common in some countries of the region and were associated with a very high mortality of up to 79%. CONCLUSION: Burn injuries remain an important public health issue in the East Mediterranean Region therefore further research is required to investigate the problem and assess the effectiveness of intervention programmes.