IRAQI JOURNAL OF COMMUNITY MEDICINE

Respiratory syncytial virus (RSV) is an important cause of respiratory infection among children and infants globally. The first line of the immune response against this virus is neutrophils, macrophages, and innate lymphoid cells. Antigen‑presenting cells such as dendritic cells which present the viral antigen to T lymphocytes that mediate viral clearance by T cytotoxic cells and initiate systemic lymphopenia. Humoral immunity will also be stimulated through B‑cell‑stimulating factors derived from epithelial cells of the respiratory tract that play an important factor in antibody production and induction memory to reinfection through IgG and IgA protective antibodies that are useful in vaccine production

Background: Pediculosis is a disease which is caused by the ectoparasite Pediculus humanus capitis. There is an estimated 19% global
prevalence of head lice infestation among schoolchildren. Health education programs have a beneficial impact on the prevention and control
of the disease. Increasing knowledge, changing attitudes and behaviors, and improving personal hygiene practices reduce the morbidity and
prevalence of pediculosis capitis. Aim of Study: The aim of the study was to assess the knowledge and practice of primary school teachers about
pediculosis capitis and to find the association of studied variables with knowledge and practice scores. Patients and Methods: A cross‑sectional
study was conducted in 20 primary schools in Baghdad, Iraq, from November 1, 2022, to January 31, 2023. It included 351 primary school
teachers who had worked for at least 1 year. A questionnaire was distributed to teachers at selected schools for assessment of knowledge and
practice. Results: In this study, 20.5% of studied cases had poor knowledge, 58% had fair and 21.5% had good knowledge. Regarding practice
level, 43% of studied cases had poor, 37% had fair and 20% had good practice about pediculosis capitis. Poor knowledge and poor practice
are significantly higher among participants with an institute level of education and lower duration of work, among singles, those who did not
have children who had arts or sports specialties, and those who did not have pediculosis capitis cases. A strong positive correlation was noticed
between knowledge and practice scores. Conclusion: The knowledge scores were fair, while the practice scores were poor. Multiple sources
are considered a major source of information. There is no association between the gender of the participant and the level of knowledge and
practice parameters.

Background: On March 2020, the World Health Organization announced that coronavirus disease 2019 (COVID‑19) has become a pandemic. In Iraq, since the start of applying the national COVID‑19 vaccine campaign, many people refused to take the COVID‑19 vaccine for various reasons, which has led to the further spread of the disease and the pandemic. Objectives: To determine some factors for refusing COVID‑19 vaccination and the beliefs about the COVID‑19 vaccine among Iraqi people in Anbar Province, Iraq. Subjects and Methods: A household‑based cross‑sectional study and a face‑to‑face interview were done on 814 participants who were involved in the survey. A convenient sample approach was followed in this study to recruit participants from 11 different areas in the entral, southern, and northern of Anbar Province, Iraq, including urban and rural regions. A questionnaire form was applied to participants enrolled in the study, and the principal researcher carried out a written interview by face‑to‑face with the participant. An analysis of data carried out using cross‑tabulated chi square test to identify variables associated with vaccine acceptance, in addition to descriptive statistics. Results: A majority (71.7%) of the population did not take any type of COVID‑19 vaccine; among those who took the COVID‑19 vaccine, 58.4% took only one dose of vaccination. Among people who did not take any type of vaccine, a high percentage of 72.1% said that they did not trust it. Others (14.3%) did not take it because their friends and relatives did not take it. A significant difference (P = 0.001) was found regarding the characteristics of those who took the vaccine and those who did not take it, including age, gender, occupation, place of residence, education level, and having had COVID‑19. Conclusion: A high prevalence of COVID‑19 vaccine refusal was found in places in Anbar Governorate based on rumors, media communication, and behavioral attitudes needs many efforts from health workers in primary health‑care centers and other health staff in other health institutions to increase people’s knowledge about the vaccine to lessen COVID‑19 vaccine hesitancy.

Background: Absenteeism is defined as the frequent nonattendance from classes with no reasonable cause. Nonattendance affects the teaching–learning practice and affects the well‑being of the class. Causes given by students for absenteeism were lack of time, illness boring, or unexciting lecture topics. Aim of the Study: The aim of this study was to determine the absenteeism behavior among students of the medical college of Al-Mustansiriyah University, Iraq, to find out the causes behind lectures’ nonattendance, and to demonstrate the rate of the most common causes. Materials and Methods: A cross‑sectional study, descriptive study, was conducted at Al‑Mustansiriyah University, College of Medicine, with a convenient sample from the third, fourth, and fifth classes, in March 2019 for 3 weeks, using a special questionnaire was made especially for the purpose of the study, and data analysis was performed using Excel trial version software and the use of descriptive statistical techniques. Results: About two‑thirds of the students missed approximately 0–5 lectures per week. The qualities of lecturers, their training, and the relationship they have with the students appear to play a role in attending lectures. The results show that about one‑third of students consider the difficult subject and their desire to benefit from the lecture influenced their decision to attend. The most common cause chosen for nonattendance was having an examination on the next day, about 66%, and lecturer expression was 63%. The most common cause for missing morning lectures was traffic problems, 53%. Conclusion: The lecture attendance rate was low, and the main reasons for absenteeism from lectures were the presence of the examination, poor lecturer teaching style, and boring lecture topics.
Keywords: Absenteeism, lecture attendance, medical students

Background: Osteoporosis is one of the major public health problems from which more and more people in the world are suffering. There is evidence suggesting that osteoporosis knowledge is one contributor to osteoporosis preventive behavior. Aim of the Study: To assess the knowledge regarding osteoporosis risk factors, prevention, and management in women of reproductive ages. To identify any association between knowledge and studied factors. Methodology: A cross‑sectional study was carried out in three primary health‑care centers (Al‑Takia, Al‑Saray, and Al‑Mustafa primary health‑care centers) from January 1, 2019, to November 31, 2019. A convenient sample of 400 women of reproductive age was selected. The data were collected using Osteoporosis Knowledge Assessment Tool through a direct interview with the women that included personal data, knowledge regarding osteoporosis risk factors, prevention, and management. Results: The majority of participants (56%) had moderate adequate knowledge about osteoporosis. The young age, being highly educated, and good economic status were significantly associated with good knowledge. Conclusion: Moderate adequate level of knowledge about osteoporosis was found among included subjects, the majority of subjects obtained their knowledge from Internet and physician. Thus, educational programs at all health‑care facilities needed to improve the knowledge of women regarding osteoporosis.
Keywords: Knowledge, osteoporosis, prevention, risk factors, women

Background: Autism is increasing in prevalence year by year worldwide. In most cases, women are the primary health‑care providers; eventually, they should manage to identify the signs and symptoms of autism and respond accordingly. The ultimate goal is to achieve optimum care for patients with autism. This study aims to ascertain the mothers’ awareness and knowledge of autism. Methodology: A descriptive study design using a purposive (nonprobability) sample of 230 women in the age range 17–48 years were included in this study from women visiting Primary Health Care Centers in Ramadi city. Results: About one‑quarter of women (25.2%) reported to have an autistic child, only 11.3% of them do not know that their children show no contact, interaction, or interest with other children. Social media were the most frequent source of information regarding autism (38.7%). About half of the women under study do not know if autism is a genetic disease. Conclusions: The study revealed a high perception of women regarding autism.
Keywords: Autism, children, Iraq, perception

Background: Penetrating abdominal trauma is a major health problem worldwide, and in Iraq, it constitutes a main job in the trauma field for general surgeons working across the country. Factors affecting the postoperative complication are well established. Moore found in 1981 that penetrating abdominal trauma score is considered an independent factor for postoperative mortality. Objective: The study aimed to evaluate patient outcomes in Al‑Yarmuk Teaching Hospital regarding postoperative morbidity and mortality using the penetrating abdominal trauma index (PATI) score. Patients and Methods: A cross‑sectional study was done for 1 year from April 2022 to April 2023 at Al‑Yarmouk Teaching Hospital; 96 patients were admitted to the theater for explorative laparotomy after having the appropriate initial management at the emergency department were included in the study; and intraoperative findings were obtained and tabulated. Basic statistical analysis to compare means and Chi‑square test for P value of complicated, noncomplicated, and mortality cases were used. Results: Patients who died scored a PATI mean of 27.16, while those who were complicated in general were 23.52, and the uncomplicated cases had a mean PATI of 10.48. Conclusion: Increasing the PATI score will increase the postoperative complications that can lead to death. This makes the PATI score >25 a risk factor for morbidity and mortality in penetrating abdominal trauma.
Keywords: Mortality, penetrating abdominal trauma index, postoperative complication

Background: Hysterectomy is a common gynecological procedure used for various benign conditions like abnormal uterine bleeding, uterine prolapse, and fibroids. Different surgical methods, including vaginal, abdominal, laparoscopic, and robotic‑assisted approaches, offer unique advantages and disadvantages. Total laparoscopic hysterectomy (TLH), introduced in 1989, offers benefits like smaller incisions, less blood loss, reduced pain, shorter hospital stays, and faster recovery. Objectives: The objective of this study was to evaluate patient outcomes, complications, and satisfaction with laparoscopic hysterectomy surgery. Patients and Methods: This cross‑sectional study was conducted in Al‑Yarmouk Teaching Hospital in Baghdad, General Surgery Department, from August 2022 to August 2023. Twenty‑five patients who underwent laparoscopic hysterectomy for benign conditions were included. Patients were carefully assessed, ruling out malignancies through extensive clinical and radiological examinations, ultimately qualifying for the procedure. Data on patients’ demographics, comorbidities, previous surgical history, uterine size, indication for hysterectomy, type of procedures performed, and postoperative complications were gathered and subjected to analysis. The follow‑up duration extended over 3 months, with assessments done on the 3rd day, 10th day, 1st month, and 3rd month postsurgery. Results: The mean age was 51.52 ± 9.47 years. Dysfunctional uterine bleeding was the most common indication (44%), followed by postmenopausal bleeding (32%). Most patients underwent TLH with bilateral salpingo‑oophorectomy (BSO) (68%), and the mean operative time was 110 min. Complications were observed in 10 (40%) cases, with common issues being blood transfusion, port‑site infection, and bladder injury. Hospitalization lasted 2 days, and postoperative pain reduced gradually over time. Patients who underwent concomitant BSO had significantly higher complications than those with isolated TLH. Postoperative pain levels were comparable between the two groups. Conclusion: Laparoscopic hysterectomy is an effective option for treating benign gynecological conditions, offering benefits like improved postoperative pain control and shorter hospital stays. However, the potential for complications, particularly in cases involving additional procedures, is to be considered.
Keywords: Al‑Yarmouk Teaching Hospital, complications, laparoscopic hysterectomy, outcome, postoperative pain

Background: Emergency cesarean sections are undertaken before or during labor when there is an immediate concern for the mother or the fetus. Inadequate maternal management and unreliable referral systems are responsible for the massive incidence of emergency cesarean section. Objectives: This study aims to identify the rate of emergency cesarean section in Kirkuk governorate. Subjects and Methods: A cross‑sectional study was conducted at the postoperative Obstetrical and Gynecological wards in Azadi Teaching Hospital and Kirkuk General Hospital, Kirkuk, Iraq, from December 1st, 2022, to February 28th, 2023. Four hundred women, who have had cesarean sections, were directly interviewed using a structured questionnaire. Official approval was obtained. Categorical data were analyzed using the Chi‑square or Fisher’s exact tests P < 0.05 was considered statistically significant. Results: One hundred and ninety‑nine (49.8%) mothers were within 26–35 years of age. One hundred and forty‑three (35.8%) had an emergency cesarean section, whereas 257 (64.3%) had an elective cesarean section. Emergency indications included failure to progress 45 (31.5%), cephalopelvic disproportion (CPD) 36 (25.2%), fetal distress 32 (22.4%), and severe preeclampsia 22 (15.4%). Poor pregnancy outcomes included bad obstetrical history 49 (12.3%), macrosomia 7 (1.8%), premature rupture of membrane 4 (1.0%), and postterm 21 (5.3%). Elective cesarean sections were significantly higher in husbands >35 years, with husbands’ education (primary school), parity of 2–4, and with no pregnancy‑induced hypertension (P = 0.035, P = 0.034, P < 0.001, and P < 0.001), respectively. Emergency cesarean sections (CSs) were significantly higher among diabetic mothers; P = 0.022. Conclusions: One‑third of all CSs in Kirkuk were done as emergency operations with failure to progress, CPD, and fetal distress as the main indications.
Keywords: Antenatal care, emergency cesarean section, poor pregnancy outcomes

Background: Obesity is a complex, chronic condition that is characterized by multiple causes and adverse health consequences. The early
detection of obesity in children can help us control it and thus improve growth and development. Objectives: To find out the prevalence
of obesity among primary school children. To find out if there is any association between childhood obesity and certain variables (age,
socioeconomic state [SES], type of school, and education of the father). Subjects and Methods: A cross‑sectional study was conducted in
the Iraq/Baghdad/Al‑Russafa sector from March 1, 2022, to January 1, 2023. The study was conducted in the First Educational Directorate of
Alrussafa. Aconvenient sample of six primary schools in Baghdad/Alrussafa including three private schools and three public schools. From these
schools, a convenient sample of 650 students was enrolled in the current study. Results: A total of 650 participants were enrolled; 249 (38.3%)
had normal weight, 241 (37.1%) of the participants were obese, 113 (17.4%) of them had overweight, and 47 (7.2%) had underweight. In
addition, a significant association was obtained between the body mass index and gender (P = 0.001), and a higher proportion of participants
was among males. There was a significant association between body mass index (BMI) and the type of school. The higher proportion of obese
participants was among those who were in private schools (P = 0.001). Conclusion: A significant association was obtained between the BMI
and gender and type of school. There was no significant association between the BMI and age, family size, or SES. The students who were
male and were teaching in private schools were more prone to be obese.

Background: Empathy is a necessary clinical skill; it is a key element of physician–patient relations which have a significant role in the
effectiveness of health care, the physician must have the competence to understand the patient’s situation, perspective, and feelings, and to
act on that understanding in a helpful therapeutic way. A highly empathetic doctor is the dream of every patient. Objective: The objective of
the study was to determine the level of empathy among physicians at Al‑Yarmouk Teaching Hospital and to assess its relation to age, gender,
and years of experience. Subjects and Methods: A cross‑sectional study was conducted among 300 physicians working at Al‑Yarmouk
Teaching Hospital in Baghdad, Iraq; the data collection was from April 14 to August 14, 2023. The data were collected by a self‑administered
questionnaire which consists of sociodemographic variables and questions of the Jefferson Scale of Empathy health professional version. Data
analysis was done using SPSS version 24. Results: Three hundred physicians participated in the study. The mean age was 31.66 ± 5.288
years, 46% males and 54% females. The mean years of experience were 6.89 ± 5.551 years, 62.7% people‑oriented physicians and 37.3%
were technology oriented the majority of the people oriented were females and the majority of technology oriented were males. The median
score was 102.00 with an interquartile range of 20.75, no significant association was found with gender or medical discipline. The median
empathy score of physicians who had <10 years’ experience appeared to be significantly higher in comparison to other groups; (P < 0.001),
and also in juniors and the age group of 25–35 years. Conclusions: Empathy scores of younger physicians with <10 years of experience were
significantly higher than other physicians, indicating that there is empathy decline as the years of experience increase that could be attributed
to numerous factors that need to be further evaluated.
Keywords: Age, Al‑Yarmouk Teaching Hospital, gender, health care, physician empathy, years of experience

Background: The red cell distribution width (RDW) is a measure of the range of variation in the red blood cell size. It reflects red blood cell
volume heterogeneity and is a part of the whole blood cell count. The use of the RDW in the diagnosis of malignant tumors has recently attracted
much attention. Related research has mainly focused on endometrial cancer, lung cancer, and liver cancer. Aim of the Study: This study
investigated the correlation between the RDW and ovarian cancer by observing changes in the RDW in patients with different stages of ovarian
cancer. Patients and Methods: A case–control study involving 50 females with ovarian cancer and 50 healthy females conducted at Baghdad
Oncology Teaching Hospital, and AlImamian AlKadhimiyain Medical City from January 1, 2022, to December 30, 2022. Data collection
included demographic data, complete blood count with the calculation of platelets to lymphocyte ratio (PLR) and neutrophiltolymphocyte
ratio (NLR), transferrin saturation, and cancer antigen 125 (CA125). Adult females with histologically proven ovarian cancer were included
in this research. Patients with conditions that affect red blood cells were excluded from the study. Results: The mean age was 52.6 ± 10.4 years
old for the cases and 50.0 ± 11.4 years for the control group. Platelets count (PLT), absolute neutrophil count (ANC), PLR, NLR, RDW, and
CA125 were significantly higher in the women with ovarian cancer in comparison to the control group (P < 0.001). RDW values were found
to be positively correlated with white blood cell, PLT, ANC, NLR, PLR, and CA125 values (P < 0.001). RDW values were also positively
associated with cancer stage; thus, higher values of RDW are to be expected with a higher stage of cancer (P < 0.001). The optimal cutoff point
for RDW was found to be 14.6% with a sensitivity of 92%, specificity of 90%, and an area under the curve of 96%. Conclusion: The RDW is
increased with ovarian cancer, and a clear cutoff point for the prediction of ovarian cancer has been observed. Furthermore, RDW was positively
correlated with cancer stage and inflammatory markers including PLT, ANC, PLR, NLR, and a tumor marker CA125.
Keywords: Inflammatory factor, ovarian cancer, red cell distribution width

Background: Communication skills are essential for health professionals to achieve a positive relationship with patients, improving their
health and quality of life. Communication is the foundation for obtaining medical history and conveying a diagnosis and treatment plan.
Objectives: To assess the knowledge, practice of communication skills among primary care physicians, to find out any barriers related to the
communication skills, and the association between the studied variables with knowledge and practice of communication skills. Methodology: A
cross‑sectional study with analytic component conducted in 40 Primary Health Care Centers in Baghdad, with data collection during a period
of 4 months from March 1, 2023 to June 30, 2023. Data had been collected in a questionnaire by direct interview with the participants done
by the researcher and including three parts: (participants’ sociodemographic characteristics, knowledge, practice toward communication
skills, and the barriers to successful communication). Results: The total number of the participants was 126. The level of knowledge of the
participants about physician‑patient communication skills was fair in 74 (58.7%) of them, poor in 35 (27.8%). The highest prevalence of poor
level of knowledge was seen in participants with specialties other than family medicine and in those with more than 20 years of experience.
Level of practice of the participants toward physician‑patient communication skills was good in 63 (50%) of them and 63 (50%) had moderate
level of practice. The highest prevalence of moderate level of practice was seen in elderly age participants. The most common barrier as
mentioned by the participants was time limitation. Conclusion: The majority of primary health‑care physicians in this study have fair levels
of knowledge, with moderate to good level of practice about communication skills. Family physicians and those who had experience between
10 and 19 years had better knowledge about communication skills. Time limitations are perceived as the biggest hindrance to communication
followed by the presentation with multiple complains.