Background Obsessive-compulsive disorder (OCD) is a common mental disorder affecting millions of people. Its onset and peak are during late teens making university students a priority target. Medical student perhaps is at greater risk for developing OCD while corona COVID-19 is expected to more exaggerate symptoms mainly with extra hygiene and cleanliness practices. The aim of the study was to estimate the prevalence of OCD symptoms among Iraqi medical students, and to assess the associated psychological symptoms and its correlates. An analytic cross-sectional study was conducted among Iraqi medical students during the period from August to October 2020. An online anonymous, voluntary, and self-administered questionnaire based on the 18 questions Obsessive-Compulsive Inventory-Revised scale (OCI-R) was used to collect the data. Results A total of 1644 students had filled the questionnaire. Females were 1116 (67.9%), while 1153 (70.1%) had reported accompanying mental symptoms. Of which worry and stress were the most prevalent with 674 (25.9%) and 617 (23.7%) respectively. However, 707 (43%) have probable OCD symptoms that need further assessment. Unpleasant thoughts were the most prevalent symptoms with 51.8%. Surprisingly, the washing and contamination scales were low at 14% and 19.4% while repeating certain numbers was the least with 8%. OCD symptoms were significantly related to younger age and earlier years of study. Further, all accompanied mental symptoms were significantly associated with probable OCD status. Conclusion High prevalence of OCD among medical students during the COVID-19 pandemic. No association of OCD with gender and family history. Younger students and early years of study were more likely to suffer from OCD symptoms.

Referral is a dynamic process and it had been recognized as crucial since the Alma Ata declaration in 1978. Hospitals are overcrowded with patients who could be more cheaply treated in smaller facilities is a common feature of poorly functioning Referral System (RS). Client Satisfaction (CS) is an important parameter in the assessment of health care quality. A descriptive cross sectional study conducted to measure CS with RS in Karbala province in Iraq. A special questionnaire based on 5 points Likert scale prepared for this purpose and been testes in a pilot study. T test were used to compare means of satisfaction. A total 726 clients from four hospitals and eight randomly selected Primary Health Care Centers (PHCCs) were interviewed. The mean age of the group was 33.4±9 years and females form 56.3% of clients. CS with RS was 19% strongly satisfied, 45.7% satisfied, 7% fairly satisfied, 22.2% dissatisfied and 6.3% strongly dissatisfied. On a score of five the overall satisfaction with RS was 3.49±1.21. Females had higher satisfaction with RS than males (p = 0.004), also PHCCs clients showed higher satisfaction than hospitals clients (p = 0.009).

Psychoactive drug use is generally low in Iraq, tobacco being highest at an estimated 23.2%. Iraqi women report significantly less substance use than Iraqi men, which may be related to cultural gender norms. Discrepancy between self-report and 'knowing someone who uses a substance' suggests under-reporting in this population.

Background Burnout is prevalent among medical students. Throughout their training, medical students face many psychosocial stresses that, if not managed, might cause burnout syndrome. Burnout could negatively impact students’ life and their academic performance. This study aims to estimate the prevalence of burnout among medical students at the College of Medicine, University of Kerbala, and assess factors associated with it. An analytic cross-sectional study. A sample of 424 students from all academic years from the College of Medicine, University of Kerbala, was approached. Data collection was conducted from June 11 to July 3, 2020, through a self-administered online questionnaire based on the Maslach Burnout Inventory Student Survey (MBI-SS). The MBI-SS included 15 questions with a 7-point rating ranging from 0 (never) to 6 (always). The tool measures three subscales: emotional exhaustion (5 questions), Cynicism (4 questions), and professional efficacy (6 questions). Statistical Package for the Social Sciences (SPSS) program version 24 was used for data analysis. Binary logistic regression was used to assess the association between burnout and students̓ variables, P value of a level < 0.05 considered statistically significant. Results The prevalence of burnout syndrome among medical students was 38.2%. About 85.6% of students had high emotional exhaustion, 77.8% had high cynicism, and 32.5% exhibited low professional efficacy. Female gender, regular use of legal substances, and family history of mental diseases were associated with significantly high rates of burnout. Conclusions Burnout is prevalent among medical students of the University of Kerbala with quite high levels of emotional exhaustion and cynicism and lower professional efficacy levels. Faculties of medicine need to consider burnout among their students and works to reduce unnecessary stresses by modifying and upgrading the educational and clinical environments.

Background: COVID-19 is a global pandemic that was first reported in Iraq on 24th February 2020, while it appeared in Nineveh on March 22nd, 2020. Infection prevention and control (IPC) is so important to minimize the risk of spreading infections.   Objectives: To assess the adherence to IPC measures among medical staff working in Nineveh governorate during COVID-19 pandemic.   Methods: A cross sectional study, using an online survey sent to different medical staff in Nineveh. The questionnaire was composed of two parts, the first included demographic information, and the second covered IPC measures. Survey was completed by medical staff witnessed COVID-19 pandemic in Nineveh governorate.   Results: The total sample was 412, of whom, 316 (77%) were males and 142 (35%) were physicians. Overall, the percentage of staff following different IPC measures was ranging from 31 % in wearing head cover, to 97% in keeping clean hands constantly. Main missed points were found in respiratory hygiene, physical distancing and self-isolation. Females were more likely to apply bandages to wounds and wearing gloves before examining patients. Compared to other medical staff, physicians were less compliant to washing hands, putting waste in designated places and wearing protective cloths. Those who work in hospitals were better compliant with sterilizing hands before entering home.   Conclusion: The adherence to IPC measures was ranging from less than one-half in wearing sterile head cover, to nearly all respondents in keeping clean hands. There is a great need to provide support as well as training in regards to IPC in Nineveh governorate city.

Background: Most primary Health Care Centers (PHCCs) in Iraq have a referral system records; however, this mechanism does not function well because of the lack of other requirements for an efficient referral system. Objective: To assess the practice & opinion of doctors in PHCs toward the referral system, and to determine the doctors in PHC's commitment to referral system instructions and guidelines. Subjects and methods: A cross-sectional study with analytic elements was conducted in nine health directorates in Iraq, from the 1st October 2018 – 30th June 2019.One PHC was selected randomly form each sector in every governorate, A questionnaire was used to collect the required information. SPSS version 24 analysis was used for the statistical analysis. Results:  sixty-three doctors were working in PHCs had participated in the current study, the mean age (40.03 ±10.24), 58.7%were female, 46% were general practitioner, 30.2% of the participated doctors had 300 and less patient/month; 31.7% of doctors had ≤10 Patients referred/month, emergencies was the main cause for referral (46.03%), and 37(58.37%) of doctors announced that the referred-form not retrained to the PHC, and ever retrained-forms had no feedback 29(46%), 28(44%)of the participated doctors agreed that the current referral-system was effective and seven of them strongly agreed, 59(93.7%) believe in the importance of hospital-feedback, with a significant relationship between their attitude about the effective-current-referral system & Refer cases Percentage, while no significant-relation with their Patients examined/month. Loaded crowded and hospital doctors shortage as possible causes and suggest to referral-system activation especially the hospital -part". Conclusions: there was inadequate knowledge of referral-policies and lack of coordination or/and clear feedback-expectations and PHCs-hospitals collaboration and lack of referral-system integrated within an electronic-health-record.

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Time delay in seeking the medical help in patients with acute coronary syndrome worsens the prognosis and increase mortality rate from this condition, this study aims to identify the status and causes of time delay in patients with acute ischemic chest pain in seeking medical help who attend coronary care unit (CCU) in AL-Hussein teaching hospital in Kerbala. A total of 129 patients admitted to the CCU over five months period in 2012 complaining of acute chest pain, their mean age was 56.8 ±11.8 years, and 67.5 % of the patients were male. The mean time between the onset of symptoms and treatment was 13.5 ± 22.7 hours. About 50% of them arrived to the hospital after more than 2 hours of the onset of chest pain. Time delay was more in old people, women, widows, patients with low educational standards, and patients with none ST elevation acute myocardial infarction. Patients who arrive after 2 hours, 59% of them claimed that they were not aware of the seriousness of the condition and 25% of them thought that the pain was transient. In conclusion, nearly half of patients arrived to the hospital after the golden hour, 84% of them were not aware of the seriousness of the condition, this indicates the need to decrease time delay mostly by public health educational program should be intensified to improve the awareness of people to the seriousness of chest pain.