Sociodemographic Characteristics and Mental and Physical Health Diagnoses of Yazidi Refugees Who Survived the Daesh Genocide and Resettled in Canada.

Importance: The health status of Yazidi refugees, a group of ethnoreligious minority individuals from northern Iraq who resettled in Canada between 2017 and 2018 after experiencing genocide, displacement, and enslavement by the Islamic State (Daesh), is unknown but important to guide health care and future resettlement planning for Yazidi refugees and other genocide victims. In addition, resettled Yazidi refugees requested documentation of the health impacts of the Daesh genocide. Objective: To characterize sociodemographic characteristics, mental and physical health conditions, and family separations among Yazidi refugees who resettled in Canada. Design, Setting, and Participants: This retrospective clinician- and community-engaged cross-sectional study included 242 Yazidi refugees seen at a Canadian refugee clinic between February 24, 2017, and August 24, 2018. Sociodemographic and clinical diagnoses were extracted through review of electronic medical records. Two reviewers independently categorized patients' diagnoses by International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes and ICD-10-CM chapter groups. Diagnosis frequencies were calculated and stratified by age group and sex. Five expert refugee clinicians used a modified Delphi approach to identify diagnoses likely to be associated with Daesh exposure, then corroborated these findings with Yazidi leader coinvestigators. A total of 12 patients without identified diagnoses during the study period were excluded from the analysis of health conditions. Data were analyzed from September 1, 2019, to November 30, 2022. Main Outcomes and Measures: Sociodemographic characteristics; exposure to Daesh captivity, torture, or violence (hereinafter, Daesh exposure); mental and physical health diagnoses; and family separations. Results: Among 242 Yazidi refugees, the median (IQR) age was 19.5 (10.0-30.0) years, and 141 (58.3%) were female. A total of 124 refugees (51.2%) had direct Daesh exposure, and 60 of 63 families (95.2%) experienced family separations after resettlement. Among 230 refugees included in the health conditions analysis, the most common clinical diagnoses were abdominal and pelvic pain (47 patients [20.4%]), iron deficiency (43 patients [18.7%]), anemia (36 patients [15.7%]), and posttraumatic stress disorder (33 patients [14.3%]). Frequently identified ICD-10-CM chapters were symptoms and signs (113 patients [49.1%]), nutritional diseases (86 patients [37.4%]), mental and behavioral disorders (77 patients [33.5%]), and infectious and parasitic diseases (72 patients [31.3%]). Clinicians identified mental health conditions (74 patients [32.2%]), suspected somatoform disorders (111 patients [48.3%]), and sexual and physical violence (26 patients [11.3%]) as likely to be associated with Daesh exposure. Conclusions and Relevance: In this cross-sectional study, Yazidi refugees who resettled in Canada after surviving the Daesh genocide experienced substantial trauma, complex mental and physical health conditions, and nearly universal family separations. These findings highlight the need for comprehensive health care, community engagement, and family reunification and may inform care for other refugees and genocide victims.

Modafinil for the Improvement of Patient Outcomes Following Traumatic Brain Injury.

Objective: The authors sought to assess the literature evidence on the efficacy of modafinil use in patients with fatigue or excessive daytime sleepiness (EDS) secondary to traumatic brain injury (TBI). Method of Research: A literature search of Medline and PubMed was performed using the EBSCOhost database. Primary literature, observational studies, meta-analyses, case reports, and systematic reviews were assessed for content regarding modafinil and psychostimulant use in patients with TBI. Of the 23 articles collected, three randomized, controlled studies, three observational studies, one case report, and two systematic reviews gave a description of modafinil use in TBI patients. Results and Conclusion: Modafinil is a central nervous system stimulant with well-established effectiveness in the treatment of narcolepsy and shift-work sleep disorder. There is conflicting evidence about the benefits of modafinil in the treatment of fatigue and EDS secondary to TBI. One randomized, controlled study states that modafinil does not significantly improve patient wakefulness, while another concludes that modafinil corrects EDS but not fatigue. An observational study provides evidence that modafinil increases alertness in fatigued patients with past medical history of brainstem diencephalic stroke or multiple sclerosis. Modafinil appears to have the potential to improve wakefulness in patients with TBI. A prospective, double-blinded, randomized, crossover trial of modafinil for the management of fatigue in ischemic stroke patients is currently being conducted, and further studies demonstrating consistent results are needed before making a conclusive decision.

Parasitic stool testing in newly arrived refugees in Calgary, Alta.

OBJECTIVE: To determine the prevalence of intestinal parasites and rates of stool testing compliance, as well as associated patient characteristics, among newly arrived refugees at the Mosaic Refugee Health Clinic in Calgary, Alta. DESIGN: Retrospective chart review. SETTING: Primary care clinic for refugee patients. PARTICIPANTS: A total of 1390 new refugee patients at the clinic from May 1, 2011, to June 30, 2013. MAIN OUTCOME MEASURES: Stool ova and parasite test completion and proportion of positive test results. RESULTS: Of 1390 patients, 74.1% (95% CI 71.7% to 76.4%) completed at least 1 stool ova and parasite test. Among those completing tests, 29.7% (95% CI 26.9% to 32.6%) had at least 1 positive result. Patients aged 6 to 18 years were more likely to have positive test results (38.5%, 95% CI 32.2% to 45.0%) than patients aged 19 to 39 were, as were those last residing in Asia (36.4%, 95% CI 30.4% to 42.8%) or sub-Saharan Africa (30.9%, 95% CI 26.8% to 35.1%), compared with those arriving from the Middle East. Giardia lamblia, Blastocystis hominis, Dientamoeba fragilis, and Entamoeba histolytica or Entamoeba dispar were the most prevalent parasites. If B hominis and D fragilis are excluded because of their lower potential to cause harm, the overall prevalence was 16.3%. CONCLUSION: Given the high compliance of patients submitting stool ova and parasite tests and a high prevalence of positive test results in some refugee groups, targeted screening should be considered in newly arrived refugees at greater risk of intestinal parasites.

Circadian control of prothoracicotropic hormone release in an adult insect and the induction of its rhythmicity by light cues.

The insect neuropeptide prothoracicotropic hormone (PTTH) is a critical regulator of larval development. We recently demonstrated that PTTH is also present in adult Rhodnius prolixus and is released by adult brains in vitro with a clear daily rhythm during egg development. Here, we employ a well-established in vitro bioassay, to show that the daily rhythm of PTTH release by brains in vitro is under circadian control since it persists in aperiodic conditions with a free running period of around 24h that is temperature compensated. Prolonged exposure (3weeks) of insects to continuous constant light (LL) completely eliminated PTTH release. Subsequent transfer of such insects from LL to constant darkness (DD) rapidly induced rhythmic PTTH release, indicating that the circadian rhythm of PTTH release is induced by photic cues. Western analysis identified PTTH in the adult hemolymph, suggesting that PTTH acts as a functional neurohormone in the adult insect. Dot blot analysis revealed that PTTH levels in the hemolymph also cycled with a daily rhythm that persisted in DD and was synchronous with the rhythm of PTTH release by brains in vitro. We conclude that the previously documented photosensitive clock in the brain regulates rhythmic PTTH release and thus generates the rhythm seen in the hemolymph. These results emphasize the importance of rhythmic PTTH release in the adult insect and support a role for PTTH in adult physiology and possibly within the adult circadian system.

Circadian regulation of hemolymph and ovarian ecdysteroids during egg development in the insect Rhodnius prolixus (Hemiptera).

Ecdysteroids, classically studied as the molting hormones of insects, occur at lower levels in the adult stage, but their source and significance in adult physiology is debated. In Rhodnius prolixus, a blood meal initiates a cycle of egg development and ecdysteroids appeared in the hemolymph within 1-2h of feeding. Systematic changes in hemolymph ecdysteroid titer then occurred during egg development. There was a clear circadian rhythm in the hemolymph ecdysteroid titer throughout egg development. This is the first report of an ecdysteroid rhythm in any adult female insect. Of various tissues examined in vitro, only ovaries released ecdysteroids. The amounts released were adequate to account for observed hemolymph ecdysteroid titers. Therefore, ovaries are the primary, perhaps sole, source of hemolymph ecdysteroids. Ovaries in vitro showed a circadian rhythm of changes in ecdysteroid content and release that was in synchrony with the hemolymph ecdysteroid rhythm, indicating that ovarian ecdysteroid release drives the rhythm seen in the hemolymph. Potential regulation of ovarian ecdysteroids is discussed in relation to the known rhythms in prothoracicotropic hormone and insulin-like peptides that occur during egg development. The prospect of circadian regulation of egg development itself by hormones and/or an ovarian clock is also discussed.

Vitamin D status of refugees arriving in Canada: findings from the Calgary Refugee Health Program.

OBJECTIVE: To determine the 25-hydroxyvitamin D (25[OH]D) serum levels in refugee women of childbearing age and in refugee children; to compare their 25(OH)D levels with the recommended levels in order to determine the prevalence of deficiency; to compare their 25(OH)D levels with those in the general Canadian population in the appropriate age and sex groups; and to investigate the association of vitamin D deficiency with potential risk factors. DESIGN: Cross-sectional chart review. SETTING: The Calgary Refugee Health Program, an urban family practice that serves newly arrived refugees in Calgary, Alta. PARTICIPANTS: A total of 1217 refugee women and children screened between June 2005 and January 2010. MAIN OUTCOME MEASURES: Serum 25(OH)D values that were measured during initial screening visits. RESULTS: Overall, 1217 of the 1768 eligible participants (69%) had 25(OH)D laboratory values recorded. The mean concentration of 25(OH)D was 52.0 nmol/L (95% CI 50.6 to 53.3 nmol/L). Using the Institute of Medicine guideline for adequate serum vitamin D levels (>50 nmol/L), 61% of women and 42% of children had lower-than-desirable 25(OH)D levels. Considering the Osteoporosis Canada guidelines, 88% of women and 81% of children had lower-than-desirable 25(OH)D levels (<75 nmol/L), and 21% of women and 10% of children were vitamin D deficient (<25 nmol/L). Mean levels of 25(OH)D were significantly lower across all age and sex groupings compared with the general Canadian population (P<.001). Women from the Middle East had lower mean 25(OH)D values (24.6 nmol/L, 95% CI 21.7 to 27.5 nmol/L) compared with women from Asia, Africa, or South America (P<.001). Mean values of 25(OH)D were lower during the winter in children (P=.01) but not in women. Female refugees between the ages of 12 and 19 years old had lower mean values of 25(OH)D than male refugees in the same age group did (P=.01). CONCLUSION: Most refugees had lower-than-desirable vitamin D levels. All age groups studied had lower mean 25(OH)D levels compared with the general Canadian population. Health care providers should be aware of this concern and consider vitamin D supplementation among refugees.

Rhythmic release of prothoracicotropic hormone from the brain of an adult insect during egg development.

Prothoracicotropic hormone (PTTH) is a brain neurohormone that has been studied for over 80 years. The only known target of PTTH is the prothoracic glands (PGs) of larvae, which synthesize the insect molting hormones (ecdysteroids) and a massive literature exists on this axis. The PGs degenerate around the time of adult emergence, yet presence of PTTH has been reported in the brains of several adult insects. Using an in vitro bioassay system, we confirm that PTTH is present in the adult female brain of Rhodnius prolixus. The material is electrophoretically, immunologically and biologically indistinguishable from larval PTTH. The amount of PTTH in the brain shows a daily rhythm during egg development. We show that brains in vitro release PTTH with a daily rhythm over this period of time. PTTH is released at each scotophase. This is the first report that PTTH is released from the adult brain and functions as a hormone, inviting explanation of its function. Larval PTTH is also known to be released with a daily rhythm, and the clock in the brain controls both larval and adult rhythms. The potential significance of rhythmic PTTH release in female adults is discussed in relation to the regulation of ecdysteroids, egg development and the concept of internal temporal order.

Transport of ammonium perfluorooctanoate in environmental media near a fluoropolymer manufacturing facility.

In order to understand better the pathways for transport of ammonium perfluorooctanoate (APFO) from a point source, a focused investigation of environmental media (water and soil) near a fluoropolymer manufacturing facility (Site) was undertaken. Methods were developed and validated at 2 microg kg(-1) [the limit of quantitation (LOQ)] in soil, and at 50 ng l(-1) in water. Environmental media were sampled from a public water supply well field located north of the Site, across a river. The data suggest that APFO air emissions from the Site are transported to the well field, deposited onto the soil, and then migrate downward with precipitation into the underlying aquifer.

The sexuality and social performance of androgen-deprived (castrated) men throughout history: implications for modern day cancer patients.

Androgen-deprivation therapy (ADT) via either surgical or chemical castration is the standard treatment for advanced prostate cancer (PCa). In North America, it is estimated that more than 40,000 men start ADT each year. The side effects of this treatment are extensive and include gynecomastia, erectile dysfunction, and reduced libido. These changes strongly challenge patients' self-identity and sexuality. The historical term for a man who has been castrated is 'eunuch', now a pejorative term implying overall social and sexual impotence. In this paper, we review key historical features of eunuch social performance and sexuality from a variety of cultures in order to assess the validity of contemporary stereotypes of the androgen-deprived male. Data were taken from secondary sources on the history of Byzantium, Roman Antiquity, Early Islamic societies, the Ottoman Empire, Chinese Dynasties, and the Italian Castrati period. This cross-cultural survey shows that castrated men consistently held powerful social positions that yielded great political influence. Many eunuchs were recognized for their loyalty, managerial style, wisdom, and pedagogical skills. Furthermore, rather than being consistently asexual and celibate, they were often sexually active. In certain cultures, they were objects of sexual desire for males, or females, or both. Collectively, the historical accounts suggest that, given the right cultural setting and individual motivation, androgen deprivation may actually enhance rather than hinder both social and sexual performance. We conclude that eunuch history contradicts the presumption that androgen deprivation necessarily leads to social and sexual impotence. The capabilities and accomplishments of eunuchs in the past gives patients on ADT grounds for viewing themselves in a positive light, where they are neither socially impotent nor sexually chaste.