Importance:Elevated low-density lipoprotein cholesterol (LDL-C) is a modifiable risk factor for cardiovascular disease, the leading cause of premature death worldwide. Assessing the LDL-C-related burden is critical for guiding prevention and treatment strategies. Objectives:To estimate the global, regional, and national burden of ischemic heart disease and ischemic stroke attributable to elevated LDL-C (relative to 35-54 mg/dL) from 1990 to 2023 and to quantify the contributions of population growth, aging, risk-deleted burden, and exposure changes to burden trends. Design, Setting, and Population:This comparative risk assessment, part of the Global Burden of Disease Study 2023, estimated population-level LDL-C exposure and associated health loss in 204 countries and territories. Mean LDL-C levels were estimated using spatiotemporal gaussian process regression based on 806 studies across 161 countries. Relative risks were derived from meta-analyses of 38 randomized clinical trials. Population-attributable fractions for deaths and disability-adjusted life-years (DALYs) were estimated by age and sex for adults aged 25 years or older from 1990 to 2023, with 95% uncertainty intervals. Exposure:Population-level LDL-C concentrations. Main Outcomes and Measures:Population-attributable fractions, counts, and rates (all ages and age standardized per 100 000) of LDL-C-attributable deaths and DALYs from ischemic heart disease and ischemic stroke, with uncertainty intervals. Results:In 2023, elevated LDL-C accounted for 3.6 million deaths (95% uncertainty interval, 2.2-5.4 million; 6.0% of global mortality) and 90.7 million DALYs (95% uncertainty interval, 58.9-123.3 million; 3.2% of DALYs). Although global all-ages rates remained stable, age-standardized death and DALY rates decreased by 45.6% and 39.5%, respectively, since 1990. In 2023, age-standardized LDL-C-attributable DALY rates were highest in Eastern Europe and lowest in high-income Asia-Pacific. One-third of the global LDL-C burden occurred in India and China. Population growth and aging drove the increasing burden, with notable regional disparities in LDL-C exposure and risk-deleted DALY rates shifting toward middle-sociodemographic settings. Conclusions and Relevance:Despite declining age-standardized rates, the absolute LDL-C burden has increased since 1990 due to demographic changes and has shifted toward middle-sociodemographic countries. Measurement and surveillance gaps persist. Strengthened prevention, diagnosis, and treatment access strategies are essential to mitigate the health burden of LDL-C.

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. 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. 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

OBJECTIVES:To evaluate the association of vitamin D linked with HbA1c level and pain severity in T2DM patients with peripheral neuropathy. METHODS:In this cross-sectional study, we included 51 patients diagnosed with T2DM and peripheral neuropathy from a main diabetes center in Kurdistan Region-Iraq. RESULTS:The study included 51 participants, predominantly female (82.35 %), with a mean age of 55.9 ± 7.55 years. Most participants had low educational attainment, with 74.51 % being illiterate, and 76.47 % were housewives. Disease duration was commonly 1-5 and 11-15 years (25.49 % each). Half of the patients used oral antidiabetic drugs, while 41.18 % used combined therapy. Medication adherence was high (94 %), and metformin use averaged 11.61 years. Statins were used by 66.67 %, and most participants were non-smokers (90.20 %). Lifestyle patterns were suboptimal, with limited fish intake and low physical activity. Obesity was prevalent (60.78 %), and glycemic control was poor, with mean fasting glucose of 225.43 mg/dL and HbA1c of 10.42 %. Vitamin D deficiency was universal. A significant association was found between pain severity, lower vitamin D, and higher HbA1c, while no associations were observed with demographic or lifestyle factors. CONCLUSIONS:The study highlights a high burden of uncontrolled diabetes, obesity, and vitamin D deficiency among predominantly female patients. Severe neuropathic pain is significantly associated with poor glycemic control and low vitamin D levels.

IntroductionSexually transmitted infections (STIs) are a major, long-lasting problem and priority for public health all over the world, coming along with various health issues. This study identified the prevalence of STIs among high school students in the Kurdistan Region of Iraq (KRI) in 2025.MethodsThe cross-sectional research was conducted on 591 high school students in the KRI as part of an STI screening program carried out by the Preventive Health Department.ResultsThe average age of the participants was 16.31 years (15–19 years), and there were slightly more women (57.2%) than men involved. 10th grade was the most populated grade, with 55.2% of students; almost all were Kurdish (98.7%) and Muslim (91.4%). In terms of risk behaviors, the majority did not have any surgery (86.5%) or dental work done (95.6%); none of them reported sharing needles or personal articles. Very few people had transfusions (0.9%), tattoos (1.0%), or piercings (0.5%). Use of illicit drugs was extremely rare (0.2%). Vaccination coverage against hepatitis B was very low (5.9%), with 81.6% of the population being unvaccinated. The results of the laboratory tests indicated that the prevalence of HBV was 0.7%, while HCV and HIV were not present. Only one case of syphilis was reported (0.2%).ConclusionThe results indicate that high school students in the Kurdistan Region of Iraq (KRI) have very low overall STI rates, with very few cases of HBV and syphilis and no HIV or HCV cases, coupled with minor involvement in high-risk behaviors. One of the concerns highlighted is the extremely low rate of HBV vaccination coverage.

Importance Elevated low-density lipoprotein cholesterol (LDL-C) is a modifiable risk factor for cardiovascular disease, the leading cause of premature death worldwide. Assessing the LDL-C–related burden is critical for guiding prevention and treatment strategies. Objectives To estimate the global, regional, and national burden of ischemic heart disease and ischemic stroke attributable to elevated LDL-C (relative to 35-54 mg/dL) from 1990 to 2023 and to quantify the contributions of population growth, aging, risk-deleted burden, and exposure changes to burden trends. Design, Setting, and Population This comparative risk assessment, part of the Global Burden of Disease Study 2023, estimated population-level LDL-C exposure and associated health loss in 204 countries and territories. Mean LDL-C levels were estimated using spatiotemporal gaussian process regression based on 806 studies across 161 countries. Relative risks were derived from meta-analyses of 38 randomized clinical trials. Population-attributable fractions for deaths and disability-adjusted life-years (DALYs) were estimated by age and sex for adults aged 25 years or older from 1990 to 2023, with 95% uncertainty intervals. Exposure Population-level LDL-C concentrations. Main Outcomes and Measures Population-attributable fractions, counts, and rates (all ages and age standardized per 100 000) of LDL-C–attributable deaths and DALYs from ischemic heart disease and ischemic stroke, with uncertainty intervals. Results In 2023, elevated LDL-C accounted for 3.6 million deaths (95% uncertainty interval, 2.2-5.4 million; 6.0% of global mortality) and 90.7 million DALYs (95% uncertainty interval, 58.9-123.3 million; 3.2% of DALYs). Although global all-ages rates remained stable, age-standardized death and DALY rates decreased by 45.6% and 39.5%, respectively, since 1990. In 2023, age-standardized LDL-C–attributable DALY rates were highest in Eastern Europe and lowest in high-income Asia-Pacific. One-third of the global LDL-C burden occurred in India and China. Population growth and aging drove the increasing burden, with notable regional disparities in LDL-C exposure and risk-deleted DALY rates shifting toward middle-sociodemographic settings. Conclusions and Relevance Despite declining age-standardized rates, the absolute LDL-C burden has increased since 1990 due to demographic changes and has shifted toward middle-sociodemographic countries. Measurement and surveillance gaps persist. Strengthened prevention, diagnosis, and treatment access strategies are essential to mitigate the health burden of LDL-C.

Adolescents' excessive consumption of sugar-sweetened beverages (SSBs) has become a global concern due to its detrimental effects on health. We explored the prevalence and associated factors of the consumption of SSB in high-school children in the Kurdistan Region. In this study, we included 560 students randomly from the 152 available high schools in Duhok City in the Kurdistan Region. Both genders of high school children who registered for the academic years 2021-2022 in 32 high schools were eligible. The study found that a considerable number of students did not eat breakfast (32.68%). Mostly, the students had lunch (83.21%) and dinner (53.57%), with 53.57% having extra eating portions. A significant percentage of the students consumed junk food (fast food) more than three times per week (39.82%) and consumed SSB 1-3 times/day (61.07%) at varying frequencies. The study found that 14.64% and 12.86% were overweight and obese, respectively. The prevalence of SSB consumption 4-5 times/week was 47.68% (soda), 21.61% (tea), 34.64% (coffee), 22.50% (energy drink), and 36.25% (juice). A similar prevalence of SSB consumption was found among parents (23.39%) and friends/classmates (20.36%). The male students were more likely to consume tea (P = 0.0104). However, female students were more likely to consume juice and energy drinks (P = 0.004 and P < 0.0001, respectively). Students with lower levels of education were also more likely to consume SSB. The intake of SSB was high among high school children in the Kurdistan Region and was related to gender and parents' consumption.

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.

ABSTRACT Background: Family caregivers who assume caregiving roles for their loved ones may experience conflict with medical staff. Therefore, our study aimed to explore the reasons behind the conflicts that have occurred between the companions of admitted coronavirus disease (COVID-19) patients and medical staff at COVID-19 hospitals. Methods: This qualitative study included 56 family members of COVID-19 patients who faced conflicts with medical staff in Duhok City, Kurdistan Region. Results: The mean ages of the patients and their family members were 58.77 and 32.20 years, respectively. The patients were admitted for a median duration of 5 days (1–40 days). Most caregivers were family members (87.50%), followed by close friends (8.93%) and friends (3.57%). Most family members reported that both nurses and doctors exhibited inappropriate behavior toward them when it came to fulfilling requests for their patients. Moreover, most reported that doctors did not provide them with the necessary information about the medicines and patients’ conditions and that nurses did not administer medications correctly or on time. A few family members reported that doctors were unavailable when needed and rarely visited the patients. Conclusion: The reasons for conflicts between family members and medical staff were identified as follows: (1) inappropriate behaviors of nurses and clinicians, (2) carelessness in administering medicines correctly and in a timely manner, (3) lack of cooperation from medical staff, (4) failure to provide information about medicines and patients, and (5) unavailability of medical staff.

OBJECTIVE:Female young prisoners may not be willing to discuss their familial and social issues through direct interviews. Therefore, other academic techniques, such as art-based techniques, could be used in this context. We aimed to explore female prisoners' psychological, familial, and social issues through an art-based approach. METHODS:In this thematic qualitative study, we conducted a 2-h painting training program for females (21-48 years) who were confined in women's shelters in the Kurdistan Region. To carry out this initiative, we collaborated with the administration of women's prisoners in Duhok, Erbil, and Sulaymaniyah governorates in the Kurdistan Region. RESULTS:The paintings included in this study explored the social and familial issues faced by girls and women who were imprisoned for various reasons. The paintings of the participants were categorized under the following three main headings: familial issues, social pressure, and women's rights. The artwork expresses that these girls and women suffer from a wide range of familial and social issues. They share that they lack the rights, as men do, to discuss their opinions and feelings within their societies and families. Additionally, these women experience pressure from their families and society for various reasons, as mentioned hereafter. CONCLUSIONS:This study revealed that the lack of meeting females' rights and their inability to practice their wishes and rights could be the main reason for the familial and social issues in Kurdish society. The findings suggest that the restrictions and limitations placed on women's agency and autonomy contribute significantly to the challenges and hardships faced by women within their families and communities. Addressing these issues and promoting gender equality may be essential in fostering a more inclusive and harmonious society in the Kurdistan region.

Background. Trust in the patient-physician relationship plays a crucial role in promoting adherence to treatment among patients in general public hospitals. Objectives. The study aimed to investigate patient-physician trust and patient adherence to treatment among outpatients, a topic that has received limited attention in literature. Material and methods. In this cross-sectional study, 666 patients who attended outpatient clinics of a main tertiary setting in the Kurdistan Region were invited through a suitable convenience sampling technique. Results. Results indicated that trust levels were higher in younger and older patients compared to middle-aged groups, as well as in rural residents, those with chronic diseases, and individuals with lower or higher educational levels. Regarding adherence, patients in specific age groups (16-19, 40-49, 50-59) demonstrated higher adherence compared to the 70-80 age group, and those with chronic diseases and white-collar occupations exhibited better adherence. The study highlighted a significant percentage of patients lacking trust in physicians regarding disease management, medical care preferences, and privacy. A considerable number of outpatients expressed negative opinions on treatment adherence. Increased trust correlated with improved adherence levels, medication adherence behavior, and positive attitudes toward medication, while negative side effects and attitudes toward psychotropic medication decreased with higher trust. Conclusions. The study concluded that the region exhibited a low level of trust between outpatients and physicians, significantly influencing treatment adherence. Key factors influencing adherence included trust in physicians, having chronic diseases, and being a non-smoker. Overall, the research emphasized the critical role of trust in enhancing patient adherence to treatment in outpatient settings.

Background/Objectives: Thalassemia is among the most common hereditary disorders globally, characterized by impaired hemoglobin synthesis and ineffective erythropoiesis. This study analyzed data on hemoglobinopathies, with a particular focus on thalassemia, to support the development of a comprehensive national database and to improve understanding of the disease burden in the Kurdistan Region of Iraq. Methods: In this retrospective cross-sectional study, a total of 910 patients admitted to the region’s sole blood disorder center since its establishment were included. Results: The study analyzed 46.7% male and 53.3% female thalassemia patients in Duhok, with 58.46% reporting parental consanguinity. Hepatitis C virus (HCV) prevalence was 11.87%, while 8.90% underwent bone marrow transplantation (BMT) and 30.11% had splenectomies. Blood group distribution was O+ (36.26%), A+ (30.99%), and B+ (18.46%). Common medications included Deferasirox (34.62%), Hydroxyurea (26.70%), and Deferoxamine (5.82%), with 8.24% and 4.40% discontinuing Deferasirox and Hydroxyurea, respectively. Geographically, 29% of the patients originated from Duhok City, which exhibited a consanguinity rate of 18.65% (p = 0.020). The most prevalent conditions were β-thalassemia major (32.53%) and sickle cell anemia (24.73%). HCV-positive patients were predominantly diagnosed with β-thalassemia major (43.40%) and sickle cell anemia (33.96%). BMT recipients were mostly β-thalassemia major patients (80.25%), while splenectomy was common in β-thalassemia major (43.40%) and sickle cell β-thalassemia (22.64%). Vaccination rates included Pneumococcal (50.78%), Influenza (47.76%), and Hepatitis (39.08%, first dose). Six patients (0.66%) died, with 30.18% diagnosed before age 1 and 43.89% between 1 and 2 years. In conclusion, this study underscores the high prevalence of β-thalassemia major and sickle cell anemia in Duhok, with strong associations to parental consanguinity and low socioeconomic status. Gaps in early diagnosis and vaccination coverage remain significant challenges.

Headache disorders, especially migraines and tension-type headaches (TTHs), are major global public health concerns, as shown by the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. We provide updated global estimates of prevalence and years lived with disability (YLDs) from 1990 to 2021 across 204 countries and territories and forecasts through 2050. In 2021, there are 2.0 billion people with TTH and 1.2 billion with migraine. Although TTH is more prevalent, migraine causes higher disability. While crude prevalence and YLDs increased, age-standardized rates remained stable and are projected to continue this trend due to population growth. There is a disproportionately higher burden in women aged 30-44 and countries with higher Socio-demographic Index and Healthcare Access and Quality Index. Despite this, migraines remain underrecognized in health policies and funding. This study emphasizes the urgent need to prioritize headache disorders in global health agendas.

Background. Due to the lack of evidence, the positive and negative experiences of companions of COVID-19 patients during their communication with medical staff in COVID-19 hospitals were explored. Material and methods. This research study encompassed a cross-sectional analysis of 437 companions of COVID-19 patients. Results. The patients' diseases were: mild (34.55%), moderate (27.92%), severe (20.14%), and critical (17.39%). The most prevalent comorbidities were cardiovascular disease (16.7%), obesity (16.48%), endocrine and metabolic disorders (14.42%), and smoking (13.73%). Out of the total of 437 patients included in the study, 23.80% died. The study revealed that 79.63% and 71.40% of companions had regular communication with the medical staff, and received relevant and sufficient information about the patients' medical conditions, respectively. Regarding mental health, 34.55% of companions reported fear of COVID-19 infection at the hospitals, and 66.59% expressed fear of patients' death. A considerable percentage had conflicts with medical staff. They expressed satisfaction with the healthcare and treatment and were informed and medical staff were available on need. The hospital environment was quiet, but not in terms of psychological well-being. Conclusions. Most companions were satisfied with treatment procedures at the COVID-19 hospitals, but a percentage were affected by ambient noise and other patients' fear.

Background: Adherence to medications is a main concern to hypertension control and incidence of CVD complications. This study aimed to measure the level of medication adherence of hypertensive patients after one month follow-up. Methods: An observational one-month follow-up study was conducted in 93 hypertensive patients in Kurdistan Region. Results: Patients’ mean age was 55.03 (25-85 years). The mean value of the MARS score of adherences was 7.68 out of 10. The mean values of dimensions of adherence were 3.20 of 4 (medication adherence behavior), 2.92 of 4 (attitude toward taking medication), and 1.55 of 2 (negative side effects and attitudes to medication). We found that the males, single and married, urban, those with no chronic disease, and those with higher levels of education were more likely to adhere to medication. The patients with shorter disease duration and treatment had higher adherence scores. The patients with no experience of the medication side effects had higher levels of medication adherence (8.80 vs. 7.00; P<0.0001) and patients who took fewer tablets/day. Conclusions: We observed high-adherence level among hypertensive patients. Prolong disease duration, long treatment duration, increase number of tablets/days, and increase number of comorbidities may significantly decrease the medication adherence rate.

Background Cancers represent a challenging public health threat in Asia. This study examines the temporal patterns of incidence, mortality, disability and risk factors of 29 cancers in Asia in the last three decades. Methods The age, sex and year -wise estimates of incidence, mortality, and disability -adjusted life years (DALYs) of 29 cancers for 49 Asian countries from 1990 through 2019 were generated as a part of the Global Burden of Disease, Injuries and Risk Factors 2019 study. Besides incidence, mortality and DALYs, we also examined the cancer burden measured in terms of DALYs and deaths attributable to risk factors, which had evidence of causation with different cancers. The development status of countries was measured using the socio-demographic index. Decomposition analysis was performed to gauge the change in cancer incidence between 1990 and 2019 due to population growth, aging and age -specific incidence rates. Findings All cancers combined claimed an estimated 5.6 million [95% uncertainty interval, 5.1-6.0 million] lives in Asia with 9.4 million [8.6-10.2 million] incident cases and 144.7 million [132.7-156.5 million] DALYs in 2019. The agestandardized incidence rate (ASIR) of all cancers combined in Asia was 197.6/100,000 [181.0-214.4] in 2019, varying from 99.2/100,000 [76.1-126.0] in Bangladesh to 330.5/100,000 [298.5-365.8] in Cyprus. The age -standardized mortality rate (ASMR) was 120.6/100,000 [110.1-130.7] in 2019, varying 4 -folds across countries from 71.0/100,000 [59.9-83.5] in Kuwait to 284.2/100,000 [229.2-352.3] in Mongolia. The age -standardized DALYs rate was 2970.5/ 100,000 [2722.6-3206.5] in 2019, varying from 1578.0/100,000 [1341.2-1847.0] in Kuwait to 6574.4/100,000 [5141.7-8333.0] in Mongolia. Between 1990 and 2019, deaths due to 17 of the 29 cancers either doubled or more, and 20 of the 29 cancers underwent an increase of 150% or more in terms of new cases. Tracheal, bronchus, and lung cancer (both sexes), breast cancer (among females), colon and rectum cancer (both sexes), stomach cancer (both sexes) and prostate cancer (among males) were among top -5 cancers in most Asian countries in terms of ASIR and ASMR in 2019 and cancers of liver, stomach, hodgkin lymphoma and esophageal cancer posted the most significant decreases in age -standardized rates between 1990 and 2019. Among the modifiable risk factors, smoking, alcohol use, ambient particulate matter (PM) pollution and unsafe sex remained the dominant risk factors between 1990 and 2019. Cancer DALYs due to ambient PM pollution, high body mass index and fasting plasma glucose has increased most notably between 1990 and 2019. Interpretation With growing incidence, cancer has become more significant public health threat in Asia, demanding urgent policy attention and guidance. Its heightened risk calls for increased cancer awareness, preventive measures, affordable early -stage detection, and cost-effective therapeutics in Asia. The current study can serve as a useful resource for policymakers and researchers in Asia for devising interventions for cancer management and control. Funding The GBD study is funded by the Bill and Melinda Gates Foundation. Copyright (c) 2023 The Author. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

This study investigates the use of artificial intelligence (AI) technologies among academics at the University of Duhok (UoD), focusing on their perspectives, preferences, and intentions toward integrating AI within academic and research environments. A survey was conducted through Google Forms, targeting postgraduate students, recent alumni (since 2020), and faculty members of UoD in the Kurdistan region of Iraq. A total of 674 participants, aged 22-70 years, responded. The findings indicate that only 36.94% had employed AI technologies. Among AI users (n = 249), primary sources of information were friends or colleagues (46.59%) and social media (35.74%). Younger individuals and those holding master's degrees exhibited a stronger tendency toward AI usage (p < 0.0001), whereas gender and academic discipline had minimal influence. ChatGPT was the most widely used tool (70.68%), followed by Quill Bot (42.17%), Grammarly (34.94%), and Google Bard (29.32%). The main AI applications were text paraphrasing (33.73%) and information retrieval (15.26%). Notably, 47.58% of respondents recommended AI for various academic tasks, including scientific research and idea generation. In conclusion, the study shows that only one-third of UoD faculty members utilize AI, predominantly for text paraphrasing. Nearly half of the participants suggested the adoption of AI by post-graduate students and academic staff.

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.

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.

Background: People frequently choose private hospitals despite public healthcare services are provided free of charge in the Kurdistan Region. We assessed quality of health services of emergency departments (EDs) between public and private sectors. Methods: In this comparative cross-sectional study, individuals who received health services from either public or private ED in the Kurdistan Region of Iraq were personally invited. Results: Most of the admitted patients in both private and public EDs were in the middle age group, female and were from urban areas. A greater proportion of government employees sought care at public EDs (20.0%) than at private ones. A considerable percentage of patients did not trust the competence of medical staff in both public and private ED. But a lower percentage of trust was found in the public ED (35.67% vs. 53.67%; P<0.0001, respectively) compared to the patients in the private ED. The patients in the private ED significantly received great attention from the medical staff, were taken seriously by the medical staff, the medical staff listened to their medical conditions, the patients had better clarity of explanations of the results of examinations. Also, the private ED had better state of seriously taken by medical staff, hygiene, and care rapidity, assessment, and clarity of explanations of the health problem. However, the private ED had worse condition about the information by medical staff on readmission in case of health problems. Conclusion: This study indicated that the private EDs provide higher quality services across various aspects compared to public EDs.