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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. In this ecological study, 186 countries with COVID-19 statistics from the World Health Organization (WHO) were included. 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 ( < 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 ( = 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 ( = 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 ( = 0.026) and pneumococcal conjugate third dose (PCV3). 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.

•Cancer children experience adverse effects.•Investigators use Art therapy for symptoms severity.•Art therapy improved the overall QoL. Children with cancer undergoing chemotherapy experience many adverse effects. The effectiveness of painting- and handcrafting-based art therapy on the various dimensions of health-related quality of life in paediatric outpatients previously diagnosed with heterogeneity of malignancy was evaluated in the present study. In an experimental randomized controlled trial, a total of 60 children aged 7–13 years previously diagnosed with malignancy together with their parents were assigned randomly either to an experimental (30 patients) or a control group (30 patients) in 2017 in Iraq. The patients in the experimental group participated in painting and handcrafting group art therapy (creative art therapy) conducted by a professional fine artist for a one-month period. The dimensions of health-related quality of life in both study groups were measured through the KIDSCREEN-10 Index after project completion. The patients in the experimental group were significantly more physically active and energetic (P < 0.001), were less depressed and emotional, and had fewer stressful feelings (P = 0.004). Moreover, they enjoyed their social and leisure time more and participated more in social activities (P = 0.003) in addition to an improvement in their relationships with other children (P = 0.043) and had better overall health status (P < 0.001). However, the children’s overall interaction with other children, parents, and healthcare providers (P = 0.074) and their perception of cognitive capacity for school performance (P = 0.257) were not significantly different between the two groups. The findings of the study suggest that exposure to painting- and handcrafting-based art therapy improves the overall health-related quality of life in children with cancer.

Despite Iraq having started the COVID-19 vaccine in January 2020, there is no official data on vaccition 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 vaccition 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.

Introduction:The Yazidi populations experienced trauma and underwent inhumane actions perpetrated by the Islamic State in Iraq and Syria (ISIS) after the invasion of the Sinjar District. We aimed to examine the effects of six-month creative art therapy sessions on cognitive functions and social avoidance and distress in traumatized females.Material and methods:In this pre- and post-experimental investigation, 15 female individuals who were distressed during the invasion of ISIS in 2014 were included. The females who registered in a non-governmental organization (NGO) in the Khanke camp were invited to participate in this study. Female Yazidi Kurdish girls and women aged 16 years and older were invited to participate in a six-month creative art therapy program (painting and drawing). Cognitive functions and social avoidance of the participants were measured before the project’s start and following its completion.Results:The median age of the girls was 23.5, between 17 and 33 years. The study showed that most of the girls had experienced emotional abuse (60.0%), physical neglect (93.33%), and sexual abuse (53.33%), and all girls had experienced emotional neglect (100%), and a small percentage were exposed to physical abuse (13.33%). The creative art-based intervention did not significantly change the score of mental state (from 95.4 to 94.67, p = 0.9348) and social avoidance and distress score (from 11.6 to 9.8, p = 0.0747) among traumatized girls.Conclusions:This study showed that a creative art-based intervention was not effective in alleviating the mental state, social avoidance, and distress among traumatized girls.

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. The clerics of members of the Union of Muslim Scholars of the Erbil branch were included through their representative in Iraqi Kurdistan in 2021. 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. This study showed that some Islamic clerics have serious concerns about the side effects of COVID-19 vaccines.

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. 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. 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). A considerable percentage of the public exhibits conspiracy thinking toward the COVID-19 crisis in Iraqi Kurdistan.

Background The increase of workplace violence (WPV) globally directed at nurses has become a primary issue of concern for many researchers. The present study was conducted to investigate WPV against female nurses coming from both patients and healthcare workers (HCWs) in the Kurdistan Region. Materials and methods A total of 257 female nurses working in different hospital units participated in the survey of this study, which determined the types of WPV such as physical assault, verbal abuse, and sexual, racial, and gender harassment through a convenient sampling method. Results The mean age of the nurses was 35.02 years. They were selected from different age groups and education levels, marital statuses, ranks, and experiences. The nurses were employed in the public sector (76.27%), and 23.73% worked in both the public and private sectors. Most of the nurses were working in the morning (44.36%) or were shift rotators (49.03%) and living in urban (88.72%) or rural (11.28%) areas. The study showed that the prevalence of WPV types during their whole career time was 65.37% (verbal abuse), 45.91% (bullying), 37.74% (physical assault), 30.74% (gender harassment), 22.96% (sexual harassment), and 16.34% (racial harassment). The study found that the nurses who did provide the general medical care were more likely to be exposed to physical assault (53.91% vs. 24.46%; p  < 0.0001), verbal abuse (77.39% vs. 56.12%; p  = 0.0004), bullying (36.52% vs. 12.23%; p  < 0.0001), and gender harassment (39.13% vs. 24.46%; p  = 0.0119). Conclusion The current study concluded that WPV against female nurses in public hospitals in the Kurdistan Region is widespread. The most frequently reported types of violence included verbal abuse, bullying, physical assault, sexual harassment, and racial harassment. We suggested the urgent need for institutional prevention policies within public hospitals in the Kurdistan Region (e.g., written zero-tolerance policies toward all forms of violence), strengthening training and capacity-building programs for nurses, and establishing confidential, easy-to-use reporting systems.

•Yezidi females suffer from mental disorders following an ISIS attack.•Art-based intervention courses are effective and non-invasive.•Psychological well-being was improved following an art-based intervention course.•Psychological Well-being of Yezidi Females Following a Group Art-Based Intervention: An Interventional Study. The Islamic State in Iraq and Syria (ISIS) attacked Sinjar, a majority Yezidi region, on 3 August 2014. ISIS fighters systematically and deliberately targeted the Yezidi Kurdish population. Several of the region’s women and girls were abducted, raped, sold and gifted to other ISIS fighters in Iraq and Syria. Amnesty International claims that the women and girls who survived ISIS captivity, or who succeeded in escaping the attack, suffer from severe psychiatric disorders, such as depression and anxiety. This paper discusses the effectiveness of a two-month art-based intervention course on the general health status and psychological well- being of Yezidi females. A total of 14 females, ranging in age from 10 to 27, who survived the ISIS captivity/invasion, were invited to participate in a two-month art-based intervention treatment course. Their general health status and socio-psychological well-being were assessed pre- and post-intervention through self-report assessments, the General Health Questionnaire-12 (GHQ-12) and the Flourishing Scale (FS), respectively. The study showed that overall general health status and socio-psychological well- being improved, substantially, from 18.21 to 3.57 for general health status (P < 0.0001) and from 41.36–51.21 for socio-psychological well-being (P < 0.0001). However, the participants were still unable to completely overcome their life difficulties (P = 0.302). Art-based intervention sessions can be effective for improving the psychological well-being of women who develop severe psychiatric disorders following the survival of war- related conflict.

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. The investigators invited individuals from different geographic areas of Duhok Governorate of Iraqi Kurdistan in March 2020. 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%). Some individuals do not adhere to preventive measures against SARS-CoV-2 infection.

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.