Effectiveness of Vitamin D supplementation in combination with calcium on risk of maternal and neonatal outcomes: A quasi-experimental clinical trial.

Objectives: We examined the effectiveness of combining Vitamin D supplementation with calcium on maternal and neonatal outcomes, as opposed to using Vitamin D supplements alone. Materials and Methods: Pregnant women in their third trimester were divided into two groups. The control group received a daily dose of 1000 IU of Vitamin D, but, the experimental group received a combined daily dosage of 1000 IU of Vitamin D and 500 mg of calcium, until delivery. Results: The women in the Vitamin D + calcium group were less likely to develop gestational diabetes (2.78%; vs. 19.51%; P = 0.0318), preeclampsia (2.78% vs. 26.83%; P = 0.004), newly onset gestational hypertension (11.11% vs. 46.34%; P = 0.001), proteinuria (5.56% vs. 39.02%; P = 0.0004), and impaired glucose tolerance (2.78% vs. 21.95%; P = 0.0163) and had lower blood pressure at 20th and 39th weeks of gestation. The newborns in the Vitamin D + calcium group were less likely to experience low birth weight (5.71% vs. 31.58%; P = 0.0066), low birth length (5.71% vs. 44.74%; P = 0.0007), were less likely to be admitted to the neonatal intensive care unit (14.29% vs. 42.11%; P = 0.0105), have a larger head circumference (35.00 vs. 33.63; P < 0.0001), longer gestational age at birth (40.0 vs. 37.56 weeks; P < 0.0001), and higher APGAR scores (9.58 vs. 6.31; P < 0.0001.) compared to Vitamin D group, respectively. Conclusions: Taking Vitamin D and calcium by pregnant women in the third trimester is an effective treatment to decrease maternal, fetal, and neonatal outcomes.

Effect of probiotics plus zinc supplementation on clinical outcomes of infants and children with acute infectious diarrhea: a randomized controlled trial.

BACKGROUND: Findings are conflicting regarding the effect of zinc supplementation on disease severity in children with acute gastroenteritis. PURPOSE: To examine the effects of probiotics and zinc on the clinical outcomes of infants and children with acute infectious diarrhea. METHODS: In this randomized controlled trial, children with mild or moderate to severe acute gastroenteritis in the Kurdistan Region from November 2021 to June 2022 were diagnosed clinically and randomly assigned to the experimental or control group. The experimental group (n=50) received probiotics and zinc, whereas the control group (n=51) received probiotics alone for 1 week. The product contained live Bifidobacterium infantis, Lactobacillus paracasei, and Lactobacillus rhamnosus (10×106 colony-forming units/day for 7 days). Zinc syrup was administered to the probiotic plus zinc group. Each 5 mL of syrup contained 15 mg of zinc sulfate. Dehydration and disease severity in both groups were measured using the Clinical Dehydration Scale and the Modified Vesikari Scale, respectively. An illness episode was defined as an episode of gastroenteritis with a total score of ≥9 on the Modified Vesikari Scale (range, 0-20). RESULTS: The probiotic and probiotic plus zinc groups were similar in age (1.79 years vs. 1.69 years, respectively; P= 0.645), sex (male/female ratio: 1.43 and 1.0, respectively; P=0.373), and medical characteristics. The groups had similar mean dehydration and disease severity scores and a similar incidence of dehydration recovery (some dehydration, 3.92% and 4.00%, respectively; P=1.000), and recovery from mild gastroenteritis (0.0% and 2.0%, respectively; P=0.495) at 2 weeks. Significant decreases in mean dehydration severity and disease severity score (1.80 to 0 and 6.66 to 0, respectively; P<0.001) and the development of dehydration (some dehydration, from 94.0% to 4.0%; P<0.001) from baseline to 2 weeks were noted in the probiotics plus zinc group. The probiotics group responded similarly. The development of mild gastroenteritis was significantly reduced from baseline to 2 weeks (90.2% to 0% and 78.0% to 2.0% in the probiotics and probiotics plus zinc groups, respectively; P<0.0001). The probiotics plus zinc group had a shorter mean recovery time (1.34 days vs. 2.00 days, respectively; P<0.001). CONCLUSION: Taking probiotics plus zinc did not significantly affect disease severity in children with gastroenteritis at 2 weeks. However, the probiotics plus zinc group recovered more quickly than the probiotics group.

Role of wet-cupping therapy in physiological and mental pains in patients with migraine: A quasi-clinical trial.

BACKGROUND: There is growing evidence of the potential benefits of wet-cupping therapy in reducing physiological pain severity in migraine; however, the role of this therapy on mental pain is unclear in this process. Therefore, this study aimed to examine the effectiveness of wet-cupping therapy on physiological and mental pains in patients with migraine. In this study, 72 migraine patients were treated with wet-cupping therapy and followed up after 1 month. METHODS: The severity of physiological and mental pain was measured before therapy, 10 minutes and 1 month following therapy. RESULTS: The study showed that patients in the wet-cupping therapy had a significantly lower mean value of physiological (0.42 vs 3.39; P < .001) and mental pain (1.60 vs 3.06; P < .001) compared to the patients in the control group, respectively. The mean value of the physiological was significantly decreased from 6.97 (baseline) to 0.73 (10 minutes) and 0.63 (1 month; P < .001) in the wet-cupping therapy patients, and the mean value of mental pain from 3.76 (baseline) to 0.71 (10 minutes) and 1.71 (1 month; P < .001). The mean values of physiological and mental pains were significantly reduced (from 7.80-3.39; P < .001) and (from 3.48-3.06; P = .0044), respectively. The level of physiological pain severity was significantly decreased with a decreasing level of mental pain severity at the posttest within the control (r = 0.5471; P = .0002) and the wet-cupping therapy (r = 0.3814; P .0412). CONCLUSION: This study showed that the physiological pain was controlled by the mental pain in the wet-cupping therapy.

Impact of short and intensive art-based intervention on symptomatology and social interactions among children with autism spectrum disorder.

BACKGROUND: Consensus on the effectiveness of art therapy in children with autism spectrum disorders (ASDs) is lacking in the literature. PURPOSE: Here, we examined the effectiveness of a short and intensive art-based intervention on autistic symptomatology and social skills among children with ASD levels 2 and 3. METHODS: This pre- and postexperimental investigation included 13 children previously diagnosed with ASD levels 2 and 3 in Kurdistan Region in 2019. They completed the art-based intervention 2 hours/day for 3 days/week for 1 month. The activities included cutting and pasting squares and triangles, coloring black-and-white images, and recognizing and coloring shapes. Children used wooden and aquatic pens and scissors under guidance. Symptom severity was measured using the Social Responsiveness Scale (SRS-2), a validated tool for measuring the severity of autistic traits and symptoms that features subscales of social awareness, social cognition, social communication, social motivation, and autistic mannerisms. Children with ASD level 2 require significant support and experience notable difficulties in verbal and social communication, while those with ASD level 3 require extensive support and have the most severe form of autism. The outcome was measured one day before the course commenced and one week after completion. RESULTS: The mean patient age (n=13) was 8.15 years (standard deviation, 1.95; range, 5-11 years). Most patients were male (n=11, 84.62%). The mean SRS-2 score did not change significantly pre- to postexperiment (159 vs. 157, P=0.601). Similarly, we found no significant changes in social awareness (19 vs. 19, P=0.779); social cognition (28 vs. 27, P=0.199); social communication (56 vs. 54, P=0.600); social motivation (26 vs. 24, P=0.684); and autistic mannerisms (33 vs. 32; P= 0.780), respectively. CONCLUSION: The art-based intervention did not improve autism symptoms or social interactions among children with ASD levels 2 and 3.

Attitudes of Islamic Clerics to Receiving COVID-19 Vaccine in Iraqi Kurdistan: A Focus Group Study.

OBJECTIVES: Religious beliefs may play a role in the rejection and acceptance of coronavirus disease (COVID-19) vaccines. We aimed to explore attitudes of Islamic clerics toward receiving the COVID-19 vaccines in a semi-structured qualitative focus group study. METHODS: The clerics of members of the Union of Muslim Scholars of the Erbil branch were included through their representative in Iraqi Kurdistan in 2021. RESULTS: This study found that both acceptance and non-acceptance focus groups approved of the existence and importance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The acceptance group intended to receive COVID-19 to protect themselves and tried to convince people to receive the vaccine. However, the non-acceptance focus group did not believe in the COVID-19 vaccine due to different reasons: (1) COVID-19 vaccines have been commercialized and politicized by the governments; (2) the government makes limitations for the people due to COVID-19; (3) making fake vaccine cards; and (4) several serious side effects of COVID-19 (death, etc.) and not receiving by health care workers. The acceptance group reported that some rumors are spread in our community and impact the public to not receive COVID-19 vaccines. CONCLUSIONS: This study showed that some Islamic clerics have serious concerns about the side effects of COVID-19 vaccines.

The Impact of COVID-19 on Individuals and Communities Through the Lens of a Kurdish Artist: A Narrative Inquiry Study.

The COVID-19 pandemic affects individuals and society at different levels. For a brief period during the pandemic, the Kurdish government closed all governmental organizations and interconnected routes, except for medical and security settings, and announced a curfew. In this article, we portray the effects of the pandemic on individuals and communities from an artist's view through an art-based narrative inquiry. Narrative analysis is used for analyzing texts or visual data in story form. It describes the life experiences of individuals and the environment in which they reside. Data came from the observations and experiences of the first author during the time he conducted research regarding the impacts of COVID-19 on different aspects of the Kurdish community in the Kurdistan Region through our previous research. The images and stories show that individuals feared COVID-19 and struggled to protect themselves from infection. They faced prolonged social distancing, quarantine, and complete lockdown and lost their family members and loved ones-their relationships with family members and others were disrupted during the pandemic. Additionally, vulnerable groups, such as children and older adults, have been especially affected psychologically during the COVID-19 pandemic. We suggest that the pandemic has affected different groups of people and impacted the health security of Iraqi Kurdistan society. Our findings add a conceptual understanding of the health threat of the pandemic that can be used to implement health services and health policy for individuals and communities in Iraqi Kurdistan.

The lived experience of surviving from the Islamic State attack and capture in Iraq and Syria: An arts-based qualitative study with Yazidi young women.

BACKGROUND: In August 2014, the Islamic State in Iraq and Syria (ISIS) attacked the Sinjar district and destroyed several villages and towns and killed several individuals. AIM: In this study, the Yazidi young women who survived the ISIS attack were encouraged to express their lived experiences through paintings following participation in a 6-month art-based intervention program. METHODS: A total of 13 Yazidi Kurdish females aged 18 to 25 years (Mean: 21.7 years) were invited to participate in an art-based (drawing and painting) course for 6 months in 2018. They were invited to draw or paint images that portrayed their lived experiences of attack and capture by the ISIS. Qualitative research situated within feminist methodology was used with the young women in this study. The interviews were analyzed using the descriptive content analysis method. RESULTS: The paintings and narratives of the participants were constructed into three main themes: fear and traumatic experiences; feeling of hopelessness; and freedom and hope. During the attack and capture, due to the escape, rape, and horrific treatments by the ISIS fighters, the young women were traumatized severely. They were sold as a sex slave by the ISIS fighters. The participants still had severe anxiety and psychological challenges after being free from the capture. However, despite their traumatic experiences and feeling of hopelessness, most of them were hoping for freedom and a better future. CONCLUSIONS: This study showed that the Yazidi young females still experienced psychological challenges burdens even 3 years after the traumatic day. However, the participants showed their resilience through feeling hopeful for freedom and a better future.

The lived experience of hospitalized and non-hospitalized health care providers of COVID-19 pandemic: a qualitative study.

This paper explores the lived experience and any mental health issues of COVID-19 survivors throughout the disease crisis using a qualitative method. The semi-structured interviewing method was conducted with COVID-19 patients who were admitted and non-admitted to hospitals in Kurdistan, Iraq. The patients had positive and negative perceptions of the COVID-19 pandemic and disease, including beliefs and thoughts about COVID-19, conspiracy thinking, and concerns toward the family and their children. The patients were affected by the disease in different ways including physical consequences of COVID-19 infection, social isolation, life changes, and mental wellbeing. But they had some coping strategies to overcome the disease, such as seeking help, preventive measures, and coping techniques. The patients had some concerns about health settings and therapeutic procedures, including lack of sufficient care, receptiveness, hospital environment, and infection guidelines. This study showed that the COVID-19 disease had devastating effects on patients either physically or psychologically.

Receiving COVID-19 vaccine, hospitalization, and outcomes of patients with COVID-19: A prospective study.

Despite Iraq having started the COVID-19 vaccine in January 2020, there is no official data on vaccination and hospitalization across the country. We aimed to explore the role of the COVID-19 vaccine on the hospitalization and outcomes of patients with COVID-19 in Iraqi Kurdistan. In this prospective study, patients who were admitted to two COVID-19 hospitals in Iraqi Kurdistan in 2021 were followed-up by the discharge time between August and November 2021. The mean age of the patients was 57.6 (27-98 years) of both genders. Most of the patients were illiterate (69.3%) or had a lower level of education (20.5%). A small percentage of patients had previous thrombotic disorders (4.7%) and close to half of the patients had chronic diseases (44.9%). The patients had mild to moderate (44.9%), moderate-severe (36.2%), and critical (18.9%) status. The median hospitalization day was 9 days (1-45 days). The study found that 91.3% of the COVID-19 hospitalized patients did not receive the vaccine and 26.8% of patients died. We did not find a significant association between receiving vaccination and patients' outcomes or disease severity. No patients with previous thrombotic disorders received the COVID-19 vaccine. The male patients were more likely to receive the COVID-19 vaccine compared to female patients; 14.55% vs. 4.17%, p=0.0394.  This study showed that most patients with COVID-19 who were admitted to the hospitals have not received the COVID-19 vaccine. A high percentage of the COVID-19 hospitalized patients died of the disease in this region.

Public Opinions and Conspiracy Thinking Toward the COVID-19 Outbreak in Iraqi Kurdistan.

OBJECTIVE: The public's perceptions toward the COVID-19 crisis and the government's attempts to handle the crisis are critically noteworthy. The public opinions toward the COVID-19 crisis were explored in this study. METHODS: In this report, 1102 participants were included from 2 popular social media platforms from the Duhok Governorate in Iraqi Kurdistan between June 2 and 22, 2020, through an online technique. RESULTS: The study revealed that 14.0% of the participants believed that there is no COVID-19 in this region, and 20.1% had no concerns about the disease spread. This study revealed that 27.4% had conspiracy thinking about the COVID-19 outbreak, including that the outbreak is a plot against/of the Kurdistan Region Government, 16.4% and 19.3%, respectively. The outbreak caused considerable changes in participants' lives (85.8%). The participants who had conspiracy thinking were younger (27.0 vs 30.0; P = 0.001) and had a higher level of education (37.50% high school and under, 26.0% college and above, 16.2% illiterate: P < 0.001). In addition, they had a private job (43.7%), and were unemployed (23.9%; P < 0.001), and had negative views on the TV information (38.9% vs 17.5%; P < 0.001). CONCLUSIONS: A considerable percentage of the public exhibits conspiracy thinking toward the COVID-19 crisis in Iraqi Kurdistan.

Experiences of nurses amidst giving care to COVID-19 patients in clinical settings in Iraqi Kurdistan: A qualitative descriptive study.

AIM AND OBJECTIVE: We explored the experiences of nurses who cared for coronavirus disease 2019 patients in Iraqi Kurdistan. BACKGROUND: Nurses play a major role in response to pandemics and epidemics in delivering patient care. The experiences of nurses who provided care have significant short and long-term consequences for individuals, communities, and the nursing profession. METHODS: Descriptive qualitative research approach was adopted in this study. We interviewed 12 nurses (22-50 years) who cared for the coronavirus disease 2019 patients in one of the clinical units of two coronavirus disease 2019 hospitals in Iraqi Kurdistan in 2020. Interviews were conducted via phone calls and were analysed using the thematic analysis method. The Consolidated criteria for reporting qualitative research checklist was applied when constructing this paper. RESULTS: The nurses had to care for a number of situations during the outbreak of coronavirus disease 2019 in Kurdistan. As people in the public did not believe that there was such a virus, nurses often had to deal with this lack of knowledge and aggression from some patients and their family members. Most nurses changed their preventive behaviours since the coronavirus disease 2019 outbreak at hospital or in public. This was mainly to protect not only themselves but their patients, colleagues, family members and friends. They were cautious about the use of a mask at the hospital and in public. Most nurses experienced fear, stress, anxiety and isolation during this period. CONCLUSIONS: The patients had some concerns about their health and staying at hospitals, and some of them had aggressive behaviours towards nurses at corona hospitals. The public, close friends and relatives of the nurses had a fear of getting the infection by the virus through the nurses. However, the nurses attempted to protect themselves, colleagues and family members, and provide the best care to coronavirus disease 2019 patients. The nurses had a high obligation towards care giving at hospitals. RELEVANCE TO CLINICAL PRACTICE: The negative experiences of the nurses regarding the care of coronavirus disease 2019 patients must be considered in clinical settings. Sensitive policy programs must be established to protect nurses from the ostracization and stigmatization of the coronavirus disease 2019 pandemic and to allow them to be able to achieve their professional practices safely.

The psychosocial experiences of healthcare workers (HCWs) during COVID-19 quarantine: a qualitative study.

Purpose: Healthcare workers (HCWs) are more than others likely to be exposed to a viral overload regardless of the protective equipment and systems. Recent studies have reported that quarantine time is stressful for healthcare workers. We explored the impact of quarantine time as an external stressor on distress, sleep, healthy lifestyle behaviors, and familial relations among HCWs during the COVID-19 pandemic. Methods: A surgery team (n = 12) were working on a patient with confirmed thyroid cancer. This team was quarantined for 14 days as per the criteria of the local health government after the patient tested positive for COVID-19. We included and interviewed this team through a purposive technique in this qualitative study in Iraqi Kurdistan in 2020. Using the Graneheim and Lundman method, we analyzed the data via thematic content analysis with a deductive approach. Results: The participants experienced distress with mental health burdens during these difficult times. Some of them had to stay away from their families and friends for the first time. The first and last days were stressful for them due to fear of infection. The HCWs attempted to maintain their healthy lifestyles, including getting sufficient sleep, reducing stress levels, and creating a positive relationship with their families. The HCWs used the following coping strategies to alleviate the effects of COVID-19: beliefs, habits, and familial support. Familial and social support were their main strategies for maintaining a healthy lifestyle. The intensity level of familial and social relations was found to be a positive experience for HCWs during this stressful period. Conclusions: This study showed that HCWs experienced psychological stress during the quarantine time of the COVID-19 outbreak. The HCWs' quality of sleep was affected adversely along with negative effects on their lifestyles. However, the level of support from familial and social relations increased during the COVID-19 outbreak. This was the major means for them to deal with stress during this difficult time of their lives.

Prevalence and correlates of COVID-19 vaccine hesitancy in the general public in Iraqi Kurdistan: A cross-sectional study.

Low vaccine acceptance is a major barrier to vaccination coverage in every health system. This study aimed to explore the prevalence and associated factors of the COVID-19 vaccine hesitancy in a sample of the general population in Iraqi Kurdistan. The general population with both genders with different educational levels and sociodemographic characteristics from the Duhok governorate was eligible to participate in this cross-sectional study in 2021. Therefore, an online Google form was sent to main pages and social groups through two main social media platforms. To obtain a representative sample of individuals with different educational levels, the author visited the main shopping center in Duhok city to collect the information from illiterate and low-level education individuals. The study found that 83.5% (n = 773) of the participants have not received and 51.4% (n = 476) did not intend to receive the COVID-19 vaccine. A small percentage has not decided to receive a COVID-19 vaccine yet (n = 17, 1.8%). The intention to receive a COVID-19 vaccine was increased with increasing level of education; 25.9%, 26.7%, 39.8%, and 53.6% in illiterate, under high school, high school, and college and higher, respectively (p < 0.0001). Healthcare workers were more likely to intend to receive a COVID-19, 57.5% vs 40.1%, p < 0.0001. Individuals who had concerns about the side effects of a COVID-19 vaccine were more likely to not receive and not intend to receive the COVID-19 vaccine. Prevalence of COVID-19 vaccine hesitancy was high in this region and was correlated with lower education and concerns about side effects.

The Response of Medical Doctors and Hospital Administration to Infection Prevention and Control in the Health Care of Suspected/Confirmed COVID-19 Patients.

The outbreak of novel coronavirus infection emerged in and spread from China to other countries. Health care workers are at significant risk of infection from this virus in medical settings. We aimed to explore and evaluate the response of medical doctors and hospital administration to infection prevention and control of suspected or confirmed COVID-19 patients. METHODS: This cross-sectional study included 108 doctors who had exposure to suspected/confirmed COVID-19 patients in public hospitals. RESULTS: The doctors were aged 24 to 53 years, working in general hospitals (72.2%), primary health centers (23.1%), and a special coronavirus hospital (4.6%). One third (33.3%) reported that their hospitals had established a clinical triage station at the entrance to the facility. Suspected COVID-19 cases were immediately placed in an area separate from other patients (63.9%). The doctors ensured that patients covered their nose and mouth with a tissue to cough or sneeze (53.7%), and they performed hand hygiene after patient contact (98.1%). A medical team designated to care exclusively for suspected or confirmed COVID-19 cases was reported by 50.9%. The screening equipment was shared among patients (56.5%). The doctors avoided moving and transporting patients out of their room or designated area (83.3%). Many hospitals (76.9%) limited the number of medical staff and visitors who come in contact with suspected or confirmed patients. Most hospitals (72.2%) did not have a surveillance process for acute respiratory infections. Only 51.9% reported that staff collecting specimens used appropriate personal protective equipment. CONCLUSIONS: The doctors reported that we adhere to infection prevention in providing health care, in contrast with hospital administration.

Clinical and epidemiological characteristics and outcomes of Coronavirus disease-19 patients in a large longitudinal study.

OBJECTIVE: This study aimed to determine the clinical and epidemiological characteristics and outcomes of Coronavirus disease (COVID)-19 patients. METHODS: In this large cohort study, 15,409 confirmed patients with the COVID-19 of different severities were followed-up from three specialized COVID-19 hospitals between March 18 and October 11, 2020 in Iraqi Kurdistan. The predictors of mortality and severity were examined in binary logistic regression analysis. RESULTS: The incidence rate of severe/critical status was 12.3% with a median age of 36.0 and case fatality rate (CFR) of 1.98%. The incidence rate of severe/critical conditions and CFR rose with increased age groups; except for 0-14 years (11.9%). The incidence rate of severe/critical patients and CFR was 8.3% and 0.5%, 21.1% and 4.0%, and 23.7% and 8.7% in 15-49 years, 50-64 years, and 65 and older age groups, respectively. The severity of the disease and CFR was associated with coexisting chronic diseases such as cardiovascular diseases (18.2% and 3.1%) and diabetes mellitus (19.8% and 3.4%). The asymptomatic patients (8400 and 54.5%) had statistically higher CFR; 2.3% versus 1.6% (P = 0.006). The most common symptoms on diagnosis were fever (31.9%), cough (23.5%), loss of smell/taste (16.3%), sore throat (15.7%), shortness of breath (9.8%), and headache (9.5%). The results showed that being older was the only predictor of mortality and severity in COVID-19 patients. CONCLUSIONS: This region has a low incidence of severe-critic status and CFR. The patients with coexisting medical conditions are more likely to have severe conditions and die of COVID-19. The older age predicts severe/critic status and higher CFR.

Effectiveness of wet cupping therapy on relieving pain in patients with chronic migraine: an observational study.

BACKGROUND: Chronic migraine is a disabling condition that negatively affects many aspects of migraineurs' lives. Patients who use pharmacological agents experience various side effects. Some studies have reported clinical improvement following wet cupping therapy in migraine patients. This study examined the effectiveness of wet cupping therapy on headache severity and its complications in patients with migraine. METHODS: In this study, a total of 29 patients previously diagnosed with migraine were treated with wet cupping therapy and followed up for headache severity. The severity of pain was measured before therapy, 1 h after therapy, and one month after therapy. The wet cupping therapy was performed by an experienced nurse who was not part of the research team. RESULTS: The mean age of the patients was 36.17 (Sta. Deviation: 10.74 years; range: 22-68 years), and on average, patients had experienced migraine for 11.14 years. The severity of headache pain was decreased significantly from 6.66 (very intense pain) before cupping therapy to 2.48 (discomforting pain) 1 h after cupping therapy and 0.72 (very mild pain) one month after cupping therapy (p<0.001). The observed complications were skin pigmentation (6.9%), skin scarring (24.1%), and itching in the cupping region (31.0%). CONCLUSIONS: The present study suggests a significant improvement in the severity of headache in migraine patients 1 h and one month after wet cupping therapy.

Exploration of Association Between Respiratory Vaccinations With Infection and Mortality Rates of COVID-19.

OBJECTIVE: Respiratory disease vaccines may affect coronavirus disease 2019 (COVID-19) - associated infection and mortality rates due to vaccine nonspecific effects against viral infections. We compared the infection and mortality rates in relation to COVID-19 between countries with and without universal respiratory disease vaccine policies. METHODS: In this ecological study, 186 countries with COVID-19 statistics from the World Health Organization (WHO) were included. RESULTS: The study found that countries with universal BCG (bacillus Calmette Guérin) vaccine had significantly lower total infection and mortality rates, 0.2979 and 0.0077 versus 3.7445, and 0.0957/1000 people and confirmed cases (P < 0.001). The countries with universal pneumococcal vaccine (PCV), including PCV1, PCV2, and PCV3 vaccines, had significantly higher total mortality, 0.0111 versus 0.0080, respectively (P = 0.032). Higher income was associated with increasing total infection and mortality rates. Whereas, BCG vaccination was associated with a lower total mortality rate only (P = 0.030). The high-income countries were more likely to not receive universal BCG and receive second dose of meningococcal conjugate vaccine (MCV2) and third dose of PCV3 vaccination coverage. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rates increased with increasing years of the second dose of measles-containing vaccine (P = 0.026) and pneumococcal conjugate third dose (PCV3). CONCLUSIONS: This study suggests that BCG vaccination could reduce the infection caused by COVID-19, and MCV2 vaccine years increases the total infection rate. This study identified high economic characteristics and not having universal BCG coverage as the independent risk factors of mortality by multivariate analysis.

Response of the Public to Preventive Measures of COVID-19 in Iraqi Kurdistan.

OBJECTIVES: On March 1, 2020, the Kurdistan Region Government (KRG) announced 4 confirmed cases of coronavirus disease (COVID-19). We aimed to explore the response of the public toward the prevention principles against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS: The investigators invited individuals from different geographic areas of Duhok Governorate of Iraqi Kurdistan in March 2020. RESULTS: The mean age of the participants was 25.74 (16-95 years). The mean score and prevalence of fear toward SARS-CoV-2 infection was 4.40 of 10 and 81.9%, respectively. A small percentage of participants did not minimize their exposures by reducing close contacts and transmission of respiratory droplets (14.5%) and visited public areas during the epidemic (28.7%). The study revealed that 30.8% of the participants do not use face masks or tissues when they sneeze in public areas. Most of the participants wash their hands when they suspect a possible transmission of the SARS-CoV-2 pathogen (94.6%) and clean or disinfect pathogen contamination-suspected areas at home (84.6%). The study also revealed that some participants (11.2%), due to a lower education, did not visit a medical clinic when they experienced possible symptoms of SARS-CoV-2 infection. Participants agreed with the health policies of KRG against the COVID-19 outbreak (90.8%). CONCLUSIONS: Some individuals do not adhere to preventive measures against SARS-CoV-2 infection.

Psychological response of children to home confinement during COVID-19: A qualitative arts-based research.

BACKGROUND: The evidence has shown that children are more susceptible to the emotional effects of traumatic events such as outbreaks with the possible disruption in their daily lives. AIM: In this paper, we discussed the psychological wellbeing of children during the COVID-19 outbreak through the art-based qualitative study using the drawing method among children in Iraqi Kurdistan. METHODS: In this qualitative arts-based research study, 15 children aged 6 to 13 years old who were confined at home during the COVID-19 outbreak for at least 1 month were included following obtaining the consent from their parents. The children were asked to draw his/her feelings, reflections, and responses during the COVID-19 on a paper. The children were guided to paint their reflections during the COVID-19 based on the following criteria: if they experienced loneliness, tiredness, insomnia, depression, worry or anxiety, or have behavior changes and their relationship with their parents and other siblings. RESULTS: This study showed that children have a high level of stress at home during the COVID-19 outbreak. The children had great fear about the coronavirus. They experienced loneliness and stress, and felt sad, depressed due to home confinement and social distancing. The possibility of infection by coronavirus has occupied their entire mind. Mental health care providers must take the experiences of children who are caught in this global pandemic seriously and ensure that appropriate care is offered to the children and their parents. CONCLUSIONS: The children exhibited a strong feeling of distress, loneliness, and fear during the COVID-19 outbreak. This has implications for mental health care.