kufa Journal for Nursing sciences

Background: Health behaviors and risk behaviors are often related to the community in a more complex pattern of behaviors associated with lifestyles. This study aimed to find out the prevalence and perceived contributing factors of physical fighting, cigarette smoking and alcohol use among adolescents in Erbil city.
Objectives: The Aim of study was assessment of health risk behavior among adolescents and young adults, as an initial step in improving their health and determining which risk behavior requires intervention.
Methodology: A cross-sectional study was conducted in Erbil, Iraq from the 4th of November 2020 through the 10th of March, 2021. A self-administered questionnaire was used to collect the data from the adolescents’ preparatory schools. 1000 students were chosen randomly out of 36777 students in high schools.
Results: The mean age + SD of the students was 16.7 + 1.2 years, ranging from 14 to 19 years. The median was 17 years. Physical fighting was the most common risk behavior among the students (28.4%), followed by smoking (13.4%), and the lowest rate of risk behaviors was for alcohol drinking (2.2%). There was significant association between age and alcohol drinking.
Conclusion: The physical fighting was the commonest health risk behavior among all male students in high schools in Erbil city. There was statistically significant association between age and alcohol drinking. future research ought to be conducted in the other governorates of Kurdistan to provide an additional accurate depiction of multiple health risk behaviors among adolescent students in high school in Kurdistan region of Iraq.

Estrogen hormone is one of the steroid hormones has a critical role in breast cancer etiology. It has been implicated in proliferation and differentiation of cells through its action promoting binding of its receptor to DNA, changing transcriptional expression of target genes. In addition to the classical DNA binding mechanism, estrogen can also regulate gene expression through a no genomic mechanism associated with activation a variety of signal transduction pathways (e.g. PI3`K/AKT, ERK/MAPK, PLC/PKCs , p38/MAPK). Dysregulation of the balance between pro-apoptotic and anti-apoptotic members of the Bcl-2 family, would result in apoptosis inhibition and tumor genesis (Chimento et al., 2022). Also, poor responses towards hormonal therapy, radiotherapy, and chemotherapy and treatment resistance are likely caused by dysregulation of apoptosis. Importantly, E2 has been shown to prevent apoptosis, first through its action in activation of anti-apoptotic proteins like Bcl-xl and Bcl-2 in breast cells like MCF-7, T47D and ZR-75-1 or due to its metabolites independently of ER. Estrogen metabolism includes several very important pathways that can possibly induce de novo DNA mutation. These pathways include:2, &4-hydroxylation, 16 α hydroxylation and 4 hydroxyestradiol-quinone-adenine/guanine adduct depurination, which subsequently participate in DNA damage that can lead to breast cancer. Endocrine resistance is considered one of the most permanent problems that can reduce the benefits of breast cancer treatment. Alteration of microRNAs expression, polymorphisms occurring in tamoxifen metabolism, and using redundant alternative signaling pathways, resulting in poor treatment responses of breast cancer patients and induction of endocrine resistance. Thus, most proposed therapeutic strategies will be based on a combination of drugs targeting various pathways alongside endocrine therapy that may improve the outcomes of endocrine responses in resistant breast cancer cells.

Background: Numerous medical disciplines have recognized the preoperative period as a crucial phase to enhance patient recovery and outcomes. Patients perform preoperative pulmonary rehabilitation with inspiratory or expiratory muscle training to enhance lung protection. Despite the variety of breathing techniques in the clinical setting, the literature lacks a conclusive evidence regarding which technique is more effective.
Research question: In adult patients undergoing open heart surgeries, is preoperative pulmonary rehabilitation of benefit in preventing postoperative pulmonary complications, shorten length of stay in the intensive care unit (ICU) or hospital?
Methodology: The authors conducted a search in electronic databases regarding the current evidence of preoperative pulmonary rehabilitation.
Subjects: Patients undergoing Coronary Artery Bypass Grafts (CABG) and/or valvular surgery.
Intervention: Any pulmonary intervention, such as incentive spirometer, inspiratory muscle training, exercise training or relaxation, delivered prior to surgery, single or combined.
Outcome measures: The incidence of persistent post-concussion symptoms (PPCSs), pulmonary function test (PFT), ventilation period, length of stay in ICU and hospital.
Results: The authors conducted an initial search in the systematic reviews, which yielded 16 published articles. Furthermore, the authors search in the randomized controlled trials and this yielded 72 articles. The relevancy of the selected publications was determined by reviewing their titles, keyword, and abstracts. Overall a total of eight randomized controlled trials (RCTs) and six systematic reviews involving 3908 participants were included in this review.
Conclusion: Preoperative pulmonary rehabilitation utilizing various breathing techniques reduces the incidence of postoperative pulmonary complications .

Background: Hospitalized patients in neurological wards require specialized nursing care. Patients’ satisfaction with the quality of nursing care is an important indicator for measuring the quality of nurses’ work. Patients are considered an important source for assessing the overall quality of hospital services, as well as the quality of nursing care in particular.
Objectives: measuring the level of hospitalized patients' satisfaction with nursing care quality in the neurological wards .
Methodology: A cross-sectional study was conducted in the present study. A purposive sample of 131 hospitalized patients in the neurological wards in Baghdad city hospitals who had met the study's inclusion criteria were targeted. The data collection started from January 21st, 2022, to March 1st, 2022. Face-to-face interviews were used for data collection. A Patient Satisfaction with Nursing Care Quality Questionnaire-Arabic (PSNCQQ-Ar) was used to measure the level of their satisfaction with the quality of nursing care.
Results: More than two thirds (88.5%) of the study participants were unsatisfied with the quality of nursing care provided to them in the neurological wards. And (11.5%) were somewhat satisfied with the quality of nursing care provided to them.
Conclusion: The majority of patients were dissatisfied with the quality of nursing care. This reflect a serious gap that must be addressed both effectively and urgently.
Recommendations: In order to increase overall patient satisfaction, the researcher suggests a number of factors be taken into account, including hospital facility improvements, and training sessions about the quality of nursing care that should be implemented for nurses to increase and improve their abilities for patient care. Also, it is possible to improve patients' satisfaction with the quality of nursing care by conducting more studies in Iraq on the qualities of good nurses such as caring and communication skills that give patients more confidence in the nursing care they get.

Background: The mammary glands are prone to various lesions, either benign or malignant, many of benign types that can mature to malignant if untreated. The breast glandular structure can undergo changes from puberty to pregnancy and menopause due to hormonal effects, so the type of lesion occurrence among women varies depending on the age.
Objectives: This study aimed to identify if there is an association between age and BIRADS classification and/ or association between age and type of lesions.
Methodology: One hundred women from the city of Kirkuk participated in this study; they underwent mammography screening for detecting breast lesions. The relationship between age and mammography screening classification has been analyzed.
Results: There is a significant association between age and BIRADS, and the age over 40 year was more frequent in most scores of BIRADS classification. In addition the number of patients with breast lesions in both BIRADS-3 and BIRADS-4 increased significantly with age. On the other hand, there is no significant association between age and types of breast lesion.
Conclusion: There is significant association between age and BIRADS

Background: pain is a critical issue in the Intensive Care Unit and need a proper management to improve patient's outcome and reduce the pain consequences in critically ill patients since patient in the intensive care unit being unable to reporting pain. Therefore, assessment vital signs frequently may be helpful.
Objectives: To describe vital signs and pain severity among critically ill patients. As well to find the relationship between pain severity and a patient's vital signs. Finally to compare the vital signs at rest, during routine nursing and post-routine nursing procedures within 20 minutes .
Methodology: A descriptive-correlational design was conducted in the present study. A purposive sample of 135 subjects who had met the study's inclusion criteria were targeted. The data collection started from January 18thto April 7th, 2022.
Results: Patients were silently suffering pain during all three assessment phases pre-during and 20 minutes’ post-routine nursing procedures. Of equal importance, there is a statistically significant association between the overall pain score and overall vital signs pre, during and post nursing procedures.
Conclusion: The pain severity had reached its highest level during nursing procedures, as it showed a severe unacceptable pain score, which is both clinically and ethically unacceptable. And there was a significant statistical difference, which was authenticated through vital signs readings during nursing procedures and within 20 minutes compared to pre-nursing procedures.
Recommendations: It is recommended to depend the changes in vital readings because it is considered important indicator of pain presence and its severity among patients who are unable to express their pain in the intensive care units. Also a highly recommended that Intensive Care Units use up-to-date clinical protocols to measure pain.

Background: Preterm birth is an important perinatal health problem, contributing to
increased mortality risk of children younger than 5 years directly and maternal
mortality indirectly. Thus, reducing the incidence and mortality of preterm birth is
significant.
Objectives: To evaluate the nursing staff's knowledge and practices regarding caring
for women with preterm birth. And to find out the relationship between nursing staff’s
knowledge and practices and their sociodemographic data.
Methodology: A descriptive design was conducted on the non-probability of (49)
nurses from four hospitals in Baghdad city.
Results: 21(42.9%) of nursing staff have a fair level of knowledge, and 38(77.6%)
have good practice. There is a high significant relationship between nursing staff'
knowledge, practice and experience years.
Conclusion: the nursing staff having a moderate level of knowledge, and a high
level of practice in the care of women with preterm birth.
Recommendations: Updating knowledge through training are important for nursing
care of women who have given birth prematurely to improve their skills and
performance to find appropriate solutions to the problems.

Background: The practice of Kangaroo Mother Care (KMC) is widely defined as a
method of skin-to-skin contact that occurs between the mother and baby. This
harmony and contact will reduce the mortality and morbidity among newborns and
more specifically the preterm babies.
Objectives: This research paper tends to examine the nurse-related factors as
barriers of Kangaroo Mother Care as they may hinder the implementation of KMC as
a practice .
Methodology: Cross sectional design was followed to conduct a quantitative
research by depending on questionnaires. Around 76 cases were collected in Rania
Pediatric and Maternity hospital. The data was analyzed with SPSS software.
Results: The results show that there is a statistically significant negative relationship
lack of experience and knowledge and kangaroo mother care, also there is a
significant and negative association between special seats and attire with KMC
implementation, however the relationship between time and tendency and KMC
implementation is not statistically significant.
Conclusion: Kangaroo mother care as an effective way of baby care has been
implemented worldwide, however several barriers face the implementation of the
practice. Via eliminating the influences of sociocultural and administrative factors,
health care providers can implement Kangaroo Mother care.

Background: Polycystic ovarian syndrome (PCOS) is the commonest endocrine disorder at a reproductive age. It is associated with numerous reproductive, metabolic and psychological abnormalities.
Objectives: The purpose of this study was to assess the association of several risk factors with the occurrence of PCOS compared to normal control group.
Methodology: A case-control study conducted in females who admitted the Maternity and Pediatric Teaching Hospital (MPTH) and who attend the private Gynecological Clinic or their Outpatient Department (OPD) of Rania Medical City (RMC) hospital for routine checkup in Rania City for duration of March 2022 to October 2022. A total of 205 females were selected to participate in this study. 103 cases of PCOS who satisfied Rotterdam ESHRE/ASRM criteria and 102 cases of age-matched controls have been recruited. Special questionnaire was constructed and designed to measure associated risk factors of PCOS. A Chi-square analysis was applied and significant predictors identified for the prediction of risk factors.
Results: The mean (range) age of the PCOS group and controls was 27.11(14-49). Females with PCOS had higher BMI, higher prevalence of infertility, obesity, and mood disorder than controls. Results revealed a statistically significant difference in accordance of BMI, infertility, anxiety and negative body image (P<0.05) between two groups. Whereas the risk of long-term consequences such as CVD and gynecological cancer were not detected. As well as metabolic risk profile were not associated with the occurrence of PCOS in present study.
Conclusion: PCOS is associated with the significant risk of development of obesity, infertility and mood disorder compared to normal control group. Screening for early detection of PCOS was crucial to assess the significance of interventions as a result prevent the health risks with this syndrome.

Background: Glucose-6-phosphate dehydrogenase deficiency is a genetic disorder that affects red blood cells, which carry oxygen from the lungs to tissues throughout the body. In affected individuals, a defect in an enzyme called glucose-6-phosphate dehydrogenase causes red blood cells to break down prematurely. This destruction of red blood cells is called hemolysis.
Objectives: To assess of nurses knowledge regarding nursing care for children with Glucose-6- phosphate dehydrogenase deficiency at the maternity and child hospital in AL-Amara city to find out the relationship between the nurses knowledge and their demographic characteristics (age, gender, level of education, years of experience and training session.
Methodology: A descriptive study assessment nurses\' knowledge about Glucose-6- phosphate dehydrogenase deficiency in children in child and birth hospital in Al-Amara city the present study was conducted for the period January 10th ,2022 to June 15,2022, the present study purposive sample comprised of (30) patients the questionnaire was a single section consisting of two parts. The first part was related to the demographic characteristics of the patients (age, gender, education level, social status) and the second part contains knowledge about the complications of the Glucose-6- phosphate dehydrogenase deficiency.
Results: The analysis of data is performed through the application of description statistic (frequency, percentage and arithmetic mean and standard deviations) and inferential statistical to present the differences between the study sample. Sample were within (21-25 years) ( the table also shows that the most of participants ( 27) 90% were female. Also In regarding to the subjects level of education, The results show that half of them has diploma in nursing in addition, years of experience years more than three quarters of nurses 25(83.4%) has (1-5 years) in the service. Addition, addition, the most of participants (25) 83.4% have training courses, and their most were number of training courses (1-5 sessions).
Conclusion: The study concluded that the majority of participants have a high level of Nurses’ knowledge regarding nursing care for children with glucose-6-phosphate dehydrogenase at the study sample. and there was no a significant relationship between nurses’ knowledge regarding nursing care for children with glucose-6-phosphate dehydrogenase and their and age.
Recommendations: The study recommended that continuous education and periodic training programs for all nurses held periodically and continuously so that the aim of these courses is to raise the quality of the nursing services provided, and adoption of brochures that contain key knowledge that nurses should know regarding therapeutic interventions for children with Glucose-6- phosphate dehydrogenase deficiency.

Background: globally maternal and neonatal mortality and morbidity identified as public health burden for this reason according to recommendation WHO 2016 guideline providing new model of antenatal care with adequate quality and number visits is responsible to decrease this risk among pregnant women and their neonates.
Objectives: objective of this study was to identify association between of antenatal care services with pregnancy outcome health status.
Methodology: this study employed quantitative design retrospective cohort study performed in Rania pediatric and maternal teaching hospital and 207 cases were collected. Questionnaire was consisted of demographic profile, antenatal care, maternal and neonatal health status information was constructed to collect data through interview technique face to face approach from 6 Jun to 7 July, a descriptive statistic used to assess frequency and percentage, inferential statistic chi square test applied to detect association between variables, the data analysis was done through statistical package for social science of software (SPSS V25).
Results: Results revealed that 99% of samples attended to antenatal care clinics, 80.6% initiated first visit in the first trimester and 69.6% performed 4 - 8 visits, moreover 47.8 % samples identified as perceived adequate care during pregnancy, and 50.7% mostly adequate care. Furthermore results illustrate that There was statistically significant association between Services of antenatal care and newborn health status (P = 0.029), however there was no significant association with mother health (P = 0.191).
Conclusion: pregnant woman’s awareness to attended antenatal clinics and services of ANC slightly high in this area so mothers with mostly adequate care had composed high proportion with no complication after delivery.

Background: Family planning is the deliberate use of contraception to arrange a couple's desired childbearing plan and number, family planning is the practice of using contraceptives to avoid unplanned pregnancies, have fewer children, and spacing out childbirths.
Objectives: To assess reasons associated with common family planning methods used among women in Qaladze district.
Methodology: A cross-sectional study was conducted on reproductive age women in Qaladze district. Data collection started on 1stof June, 2022 and ended in 1st, August, 2022.a non-probability purposive sampling used to recruit 180 women who were living in Qaladze district and its surroundings. Special questionnaire constructed for proper data collection based on extensive review of related literature and studies. For data processing and statistical analysis, the statistical program for social science (SPSS, Version 25) was used.
Results: The mean age of the respondents was (34 ±6.842),most of the study samples were illiterate (14.4%n=35) With regards to the residential area of the study participants a large number of them were came from urban residents (78.9%, n=142). (80.6%, n=145) of them were nuclear parents. Regarding the reasons for using the current method of contraception, most common reason for choosing was healthiness and safety (55.6%, n=100) least common chosen reason for using contraceptive methods was cheapness (22.2%, n=40).concerning to the common contraceptive method used in Qaladze district, the majority were usecoitous interruptus(51.7%).
Conclusion: More than half of them in Qaladze chose healthiness and safety as a reason for using their current contraceptive method, common contraceptive method used in the area was coitous interruptus which holds more than half of the participants, following by condom users, least methods used by them were lactational amenorrhea and injectable contraceptives.