Project description:BackgroundPeople who suffer from mental illness, the professionals who treat them, and indeed the actual concept of mental illness are all stigmatised in public perception and often receive very negative publicity. This paper looks at Iraq, which has a population of 30 million who are mainly Moslem. Mental health services and professionals have historically been sparse in Iraq with 1 psychiatrist per 300,000 before 2003 falling to 1 per million until recently and 1 primary care centre (40 Healthcare Workers including 4 General Practitioners) to 35,000 population, compared with 1 GP per 1700 population in the UK.MethodsWe aimed to assess public attitudes and perceptions to mental illness. Participants were asked to complete a questionnaire (additional file 1), which was designed specifically for Iraqi contexts and was made available in 2 languages. The survey was carried out in 500 participants' homes across 2 districts of Baghdad.ResultsThe response rate of the survey was 86.4%. The paper shows respondents views on the aetiology of mental illness, perceptions of people with mental illness and attitudes towards care and treatment of people with mental illness.ConclusionsThis survey of public attitudes towards mental illness in Iraq has shown that community opinion about the aetiology of mental illness is broadly compatible with scientific evidence, but understanding of the nature of mental illness, its implications for social participation and management remains negative in general.
Project description:Doctor shopping is the practice of visiting multiple physicians to obtain multiple prescriptions. Health information technology (HIT) allows healthcare providers and patients to leverage records or shared information to improve effective care. Our research objective was to determine how HIT is being leveraged to control for doctor shopping. We analyzed articles that covered a 10-year time period from four databases and reported using preferred reporting items for systematic reviews and meta-analysis (PRISMA). We compared intervention, study design, and bias, in addition to showing intervention interactions with facilitators, barriers, and medical outcomes. From 42 articles published from six countries, we identified seven interventions, five facilitator themes with two individual observations, three barrier themes with six individual observations, and two medical outcome themes with four individual observations. Multiple HIT mechanisms exist to control for doctor shopping. Some are associated with a decrease in overdose mortality, but access is not universal or compulsory, and data sharing is sporadic. Because shoppers travel hundreds of miles in pursuit of prescription drugs, data sharing should be an imperative. Research supports leveraging HIT to control doctor shopping, yet without robust data sharing agreements, the efforts of the system are limited to the efforts of the entity with the least number of barriers to their goal. Shoppers will seek out and exploit that organization that does not require participation or checking of prescription drug monitoring programs (PDMP), and the research shows that they will drive great distances to exploit this weakest link.
Project description:This study provides a global assessment of the linkages between observed fisheries-related offenses across the world's oceans between 2000 and 2020. We analyze data from the largest existing repository with 6853 events reporting offenses across 18 fishing-related categories, including illegal fishing, human rights abuses, and smuggling. We find that at least 33% of all recorded offenses are associated with 450 industrial vessels and 20 companies originating from China, the EU, and tax haven jurisdictions. We observe links between various types of offenses for 779 vessels, with such "transversal criminality" involving 2000 offenses and crimes globally. This study demonstrates the ability to identify offenders and patterns of behaviors threatening fisheries sustainability at a global level and countries most vulnerable to transversal criminality. In light of concerns for widespread underreporting and impunity, we call for greater information sharing, interagency cooperation, and stringent enforcement to bring to account major offenders.
Project description:ObjectivesCrimean-Congo hemorrhagic fever (CCHF) is the most widespread tick-borne viral disease worldwide. CCHF was not recognized in Iraq before 1979, after which many outbreaks occurred, and the disease became endemic with the re-emergence of outbreaks. This study aimed to analyze the epidemiology of the largest outbreak in Iraqi history in 2023.MethodsThis retrospective study included human CCHF cases from 2023.Results2186 suspected cases were investigated. There were 587 confirmed cases, and 83 deaths, and an overall case fatality rate (14%). Among the confirmed cases, only 539 cases had complete data, and the analysis was performed on these cases. The majority 70.9% of patients lived in the southern provinces. Approximately 58% of the patients were male and up to half of the patients resided in rural areas. Approximately 45% of cases were in the 25-44 years age group. The occupations of the patients were as follows: 30% were housewives, 22% were butchers, 18% were animal owners, 30% had other occupations, and up to 60% had a history of exposure to fresh raw meat.ConclusionsThe 2023 outbreak was the largest in Iraq in decades. The absence of preventive and control activities during the COVID-19 pandemic played an important role in the rise of cases and the presence of unlicensed and freelance slaughterers, especially during religious events played an important role in this epidemic.
Project description:ObjectivesTo examine how the public assess trust in health care in England and Wales.DesignPostal structured questionnaire in cross sectional survey.SettingRandom sample of people on the electoral register in England and Wales.SubjectsPeople aged 18 and over.Main outcome measuresGeneral levels of trust and confidence in health care.ResultsThe response rate was 48% (n = 1187). The mean level of confidence (trust) in the healthcare system was 6.0 out of a score of 10. Levels of distrust appeared relatively high with at least 356 (30%) respondents reporting little or very little trust for 28 of 32 specific aspects of health care. The highest levels of distrust were found in relation to how the health service was run and financed, particularly waiting times and the implication of cost cutting for patients. Statistical analysis by univariable linear regression of the specific determinants of generic assessments of public trust (confidence) suggested that the key aspects were patient centred care and levels of professional expertise. Being covered by private health insurance was also a key determinant of levels of public trust.ConclusionPublic assessment of trust tends to address the views of care at the micro level. Policy makers concerned with the erosion of public trust need to target aspects associated with patient centred care and professional expertise.
Project description:Extralegal factors may influence judicial outcomes. Here we investigated the experience of incidental haptic sensations on the harshness of punishment recommendations. Based on recent theories of embodiment, which claim that cognitive representations are structured by metaphorical mappings from sensory experience, we hypothesized that tactile priming with hard objects would cause subjects to recommend harsher sentences (to be 'hard on crime'). Furthermore, the theory of embodiment predicts that this effect should be based on sensorimotor brain activation during the judging process. In order to test this we presented participants with scenarios that described various crimes while scanning their brain activity with fMRI. Participants were then asked to rate how severely they would sentence the delinquents. Before the scenarios, the participants were primed by touching either a hard or a soft object. Results revealed tha t hard priming led participants to recommend harder punishments. These results were accompanied by activation of somatosensory brain areas during the judging phase. This outcome is in line with simulation assumptions of the embodiment theory and proposes a central role of the sensorimotor cortices for embodied metaphors. Thus, incidental tactile experiences can influence our abstract cognitions and even how hard we are on criminals.
Project description:Primary care has been viewed as a means to ensure equitable access to care, enhance efficiency within healthcare systems, and improve health service quality. In recent decades, Iraq has transformed its compromised health system, shifting the healthcare model from hospital-based to primary care through primary health centers (PHCs) and referral mechanisms. Based on an extensive literature review, this qualitative paper explores the healthcare utilization of PHCs in different regions of Iraq. It also identifies some barriers to PHC use and recommends evidence-based approaches for improving PHCs' performance. Some reported challenges to better utilizing PHCs were the poor quality of services, patient dissatisfaction, long walking distance to a health center, and limited availability and affordability of the medications. If Iraq is to use primary care as a tool in achieving sustainable development goals (SDGs), collaborative efforts addressing the facility-related factors should be a priority.
Project description:Obesity is a growing public health concern and is becoming an epidemic among veterans in the post-deployment period.To explore the relationship between body mass index (BMI) and posttraumatic stress disorder (PTSD) in a large cohort of Iraq and Afghanistan veterans, and to evaluate trajectories of change in BMI over 3 years.Retrospective, longitudinal cohort analysis of veterans' health recordsA total of 496,722 veterans (59,790 female and 436,932 male veterans) whose height and weight were recorded at the Department of Veterans Affairs (VA) healthcare system at least once after the end of their last deployment and whose first post-deployment outpatient encounter at the VA was at least 1 year prior to the end of the study period (December 31, 2011).BMI, mental health diagnoses.Seventy-five percent of Iraq and Afghanistan veterans were either overweight or obese at baseline. Four trajectories were observed: "stable overweight" represented the largest class; followed by "stable obese;" "overweight/obese gaining;" and "obese losing." During the 3-year ascertainment period, those with PTSD and depression in particular were at the greatest risk of being either obese without weight loss or overweight or obese and continuing to gain weight. Adjustment for demographics and antipsychotic medication attenuated the relationship between BMI and certain mental health diagnoses. Although BMI trajectories were similar in men and women, some gender differences were observed. For example, the risk of being in the persistently obese class in men was highest for those with PTSD, whereas for women, the risk was highest among those with depression.The growing number of overweight or obese returning veterans is a concerning problem for clinicians who work with these patients. Successful intervention to reduce the prevalence of obesity will require integrated efforts from primary care and mental health to treat underlying mental health causes and assist with engagement in weight loss programs.
Project description:Medical claims were analyzed from 2810 military children who visited a civilian emergency department (ED) or hospital from 2000 to 2014 with behavioral health as the primary diagnosis and TRICARE as the primary/secondary payer. Visit prevalence was estimated annually and categorized: 2000-2002 (pre-deployment), 2003-2008 (first post-deployment), 2009-2014 (second post-deployment). Age was categorized: preschoolers (0-4 years), school-aged (5-11 years), adolescents (12-17 years). During Afghanistan and Iraq wars, 2562 military children received 4607 behavioral health visits. School-aged children's mental health visits increased from 61 to 246 from pre-deployment to the second post-deployment period. Adolescents' substance use disorder (SUD) visits increased almost 5-fold from pre-deployment to the first post-deployment period. Mental disorders had increased odds (OR = 2.93, 95% CI 1.86-4.61) of being treated during hospitalizations than in EDs. Adolescents had increased odds of SUD treatment in EDs (OR = 2.92, 95% CI 1.85-4.60) compared to hospitalizations. Implications for integrated behavioral health and school behavioral health interventions are discussed.