The Iraqi People Impact of Six Decades of Trauma; on the Health Presenter Hikmet Jamil, MD, DVD, DIH, MSc, PhD, AFOM, MFOM, FFOM, FPH
2nd IFSFMCI Conference held at Holy Karbala/ Iraqi Secretariat of the Imam Hussain Holy shrine 6-7 December 2017
Research Team • Hikmet J. Jamil, MD, PhD1; Manhel Reemon Aziz, PhD2; Nadia Al-Noor, PhD3; Taghreed Al Noor, PhD4; Thamer Hamdan, MD, FRCS5 • Michigan State University, Department of Family Medicine, Michigan, U.S. • Wayne State University, Department of Nutrition and Food Science, Michigan, U.S (Volunteer adjunct faculty). • Mustansiriyah University, Department of Mathematics, College of Science, Baghdad, Iraq. • University of Baghdad, Department of Chemistry, Education for Pure Science College, Ibn- Al Haitham, Baghdad, Iraq. • University of Basra, Department of Surgery, Basra Iraq
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Conference Aims The Conference Designed To Bring Together:– Fingerprint Practitioners, – Educators And – Researchers
To Enhance Information-sharing & Promote Collaboration Among The Forensic, Law Enforcement, Academic, Biometric, And Legal Communities Nationwide.
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Presentation & Conference
The Presentation Will Explore The Relation Between The Trauma That The Iraqis Exposed In The Last Six Decades & Its
Risk Factors, To Enhance The Iraqi Government To Establish Public Health Program Leading To Wellbeing of Iraqi
People.
Study Objectives •
To Explore The Prevalence of Trauma
Through Mental Dis. & Substance Abuse Among Iraqis Inside & Outside Iraq,
•
To Explore The Risk Factors For Mental Diseases, Substance Abuse & Wellbeing
(Through Self-rated Health) Among Iraqis
Inside & Outside Iraq. 5
Hypothesis
We Hypothesis That ❖Iraqi People Inside Iraq Will (1) Suffer More Mental Diseases, (2) Use More Substance Abuse & (3) Have Worse Health
❖Compare To Iraqi Outside Iraq (USA). 6
Introduction
Literature Reviews Indicate: ❖Relationship Between Mental Diseases & Crime ❖Relationship Between Using Extensive Illicit Drugs & Crine ❖One of The Most Significant Areas of Risk With The Use of Alcohol & Drugs Is The Connection Between Alcohol, Drugs & Crime. 7
Introduction
• 1.9 Million Of 2.4 Million Juvenile Arrests Had Substance Abuse & Addiction Involvement • Each Year, More Than 600,000 Students Between The Ages of 18 & 24 Are Assaulted By Another Student Who Has Been Drinking. • 95% of All Violent Crime on College Campuses Involves The Use of Alcohol 8
9
2003-14
2014-17 Civil War against ISIS
instability
After U.S. Invasion
1990-91 IraqKuwait War
Sources of Trauma on Iraqi People 1963 -2017 1963-2003 Iraq under Dictatorship
19912003 Iraq Under Sanction
1980-88 IraqIran War 10
11
TV
Political
Violence
Power
Poverty
Illicit Drugs
Major
Child Abuse, Rape women, Widow, Divorce
Exposure To
Victim Unfair Ruling from Court
Trauma
Disable & Injured Person
Death of Love Person
Discrimination
Overcrowd At Household 12
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Physical Damages
Emotional Shocks
Denial, Anger
Response To Trauma
Acute Stress Disorder
Secondary Injuries 14
Method / Study Population
❖ Data of Four Scientific Researches Which Were Conducted In Michigan USA, Between 2000 & 203 & One Scientific Research Was
Conducted In 2001 In The South of Iraq, Will Form The Data of Presentation
❖ Several articles were published from these data
Method / Study Population • There Were No Significant Difference Between The Four Extracted Data From The Original Data Which Was Conducted In Michigan, USA, When We Applied ANOVA Analysis, for that reason we combined them as one group vx the study nwhich was conducted inside Iraq 16
Method / Study Population ❖ Only Iraqis Male Were Selected From the four Studies which were conducted in USAn ❖ The other one study was conducted in the South of Iraq among Iraqi people. ❖ Only Related Variables To The Study Objective Were Selected From These Studies 17
Methods/ Cont.
❖Participants Of Theses Studies Were Collected From The Community On The Following Bases: ❑Convent Sample (642 Participants) ❑Random Sample (1727 Participants) ❑Making A Total Of 2369participants 18
Method / Study Population
❖Major Variables Were As Follows: ❑Mental Diseases (Depression, PTSD, Anxiety) ❑Substances Abuse (Illicit Drugs, Alcohol, Tobacco) ❑Somatic Diseases Which Could Related To Mental Diseases (Diabetes, Heart Problems, Hypertension, Sexual Problems) 19
Method / Study Population ❖All These Studies Have Got Approval From
Institute Review Board (IRB) From Wayne State University &From Basra University,
❖All Participants In These Studies Sign Consent &Voluntarily Participates In These Studies,
❖Chi-square Test, Logistic Regression & Analysis Of Variance – “ANOV” Were Used 20
Results
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Numbers of Study Population by Location 2301
1155
1146
Iraqis In Iraq
Iraqis in USA
Total
22
Number of Study Population by Period Left Iraq to USA & Study Population 1146
711 403 32 1981-1990
1991-2003
2004 -2007
Total
Years Arrive USA
23
% of Iraqi at Outside Iraq by Legal Status (P< 0.001) Iraqis in USA
Immigrants 35% Refugees 65%
24
Study Population by Age Group (P<0.001) Iraqis In Iraq
Iraqis in USA
91.5
65.9
34.1
8.5
18-29 Age
30 + Age
25
Study Population by Marital Status (P < 0.001) Iraqis In Iraq
Iraqis in USA
71.3 62.4
37.6 28.7
Married/Other
Single
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Study Population by Level of Education (P < 0.04) Iraqis In Iraq 59.4
Iraqis in USA
55.8
44.2
40.6
< H.S
HS +
27
Study Population by Employment Status (P < 0.001) Iraqis In Iraq
Iraqis in USA
95.9
63.8
36.2
4.1 Unemployed
Employed
28
Prevalence of Tobacco Smoke among Study Population (P < 0.001) smoke Tobacco 51.3 40.7
Iraqis In Iraq
Iraqis in USA
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Respond of Study Population by Those who Drink Alcohol (P < 0.001) Drink Alcohol 28.0
1.9 Iraqis In Iraq
Iraqis in USA
30
Prevalence of Using Street Drugs* by Study Population (P < 0.001) Use Street drugs 15.6
11.5
Iraqis In Iraq
Iraqis in USA
Note: Cocaine / Margarine / Tranquilizer / Amphetamine / Pain Killers / Crack, Hallucinogens, Heroin, Narcotics
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Prevalence of All Substance Abuse* by Study Population (P< 0,001) One or more Substance Abuse 60.5
55.0
Iraqis In Iraq
Iraqis in USA
* Smoke Tobacco + Drink Alcohol + Use Street Drugs
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Linear regression Analysis to Predict Risk Factors for All Substance Abused* 95% C.I. for OR
Risk Factors
Iraqi in Iraq Age Married/Other Have less than H.S. Employed Have stress of life One or more Mental dis one or more somatic dis
B
Sig.
OR Lower
Upper
1.10
0.000
3.01
1.89
4.78
0.02
0.022
1.02
1.00
1.04
0.28
0.048
1.32
1.00
1.74
-0.30
0.027
0.74
0.57
0.97
1.08
0.000
2.95
1.78
4.89
0.38
0.022
1.47
1.06
2.04
0.47
0.001
1.60
1.21
Dis.
0.40
0.039
1.50
1.02
2.20
* Variables in Equation: Age, Study Population, Marital Status, Education, Legal status, Employment, All Chronic diseases, All Somatic All Mental Diseases, Chemical Exposure, Non-Chemical Exposure, Stress of life 33
Prevalence of Depression* among Study Population (P < 0.001) Depression 37.2 30.0
Iraqis In Iraq
* M Minor depression
Iraqis in USA
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Prevalence of PTSD among Study Population (P < 0.001) PTSD 13.6
0.5 Iraqis In Iraq
Iraqis in USA
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Prevalence of Anxiety among Study Population (P < 0.001) Anxiety 22.7
10.1
Iraqis In Iraq
Iraqis in USA
36
Prevalence of All More Mental Disease* among Study Population (P < 0.001) One or more Mental dis 57.1
38.5
Iraqis In Iraq
Iraqis in USA
* Depressionâ&#x20AC;&#x2122; PTSD; Anxiety; Other Mental diseases
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Binomial Logistic Regression Analysis to Predict Risk Factors for All Mental Diseases 95% C.I.for OR Risk Factor
Iraqi in USA one or more somatic dis One or more substance abuse Employed
B
Sig.
0.00 0 0.00 0.70 0 0.00 -0.46 1 0.00 0.77 4 -1.40
OR Lower
Upper
0.25
0.15
0.39
2.02
1.36
2.99
0.63
0.48
0.83
2.15
1.27
3.63
* Variables in Equation: Age,, Marital Status, Education, Legal status, Employment, All Chronic diseases, All substance abuse, Chemical Exposure, Non-Chemical Exposure, Stress of life
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Prevalence of Hypertension among Study Population P < 0.001) Hypertension 19.5
9.0
Iraqis In Iraq
Iraqis in USA
39
Prevalence of Heart Problems among Study Population (P < 0.001) Heart Problems 9.2
2.3
Iraqis In Iraq
Iraqis in USA
40
Prevalence of Diabetes Mellitus among Study Population P < 0.001) Diabetes 12.2
2.8
Iraqis In Iraq
Iraqis in USA
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Prevalence of All Somatic disease* by Study Population (2539) (P< 0.0001) one or more somatic dis. 28.4
11.9
Iraqis In Iraq
Iraqis in USA
* Hypertension + Heart Problems + Diabetes + Sexual Problems
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Binomial Logistic Regression Analysis to Predict Risk Factors for All Somatic Diseases Risk Factor
B
Sig.
OR
95% C.I.for OR Lower
Upper
Poor to Bad Health
0.87
0.000
2.40
1.60
3.60
One or more Mental diseases
-0.63
0.002
0.53
0.36
0.79
Variables in Equation: Study population, Age,, Marital Status, Education, Legal status, Employment, All substance abuse, Chemical Exposure, Non-Chemical Exposure, Stress of life 43
% of Stress of Daily Life among Study Population ( (P< 0.001)
85.8 53.7
Inside
Outsode
Iraqi Population Studied 44
Prevalence of Chemical Exposure* during Gulf War 91 among Study Population (P < 0.001)
42 18.2
Inside
Outsode
Iraqi Population Studied * E.g. smoke from oil well fires, and other petrochemical fuels.
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% of Study Population to How they Evaluate Their Current Health (P < 0.001) SRH Iraqis In Iraq
Iraqis in USA
87.0 60.5 39.5 13.0
Poor to Bad Health
Good to Excellent Health
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Linear regression Analysis to Predict Risk Factors for Excellent Health 95% C.I.for OR
Risk Factor
No Chemical Exp. No Somatic Disease No Mental Disease Iraqi in Iraq
B
Sig.
OR Lower
Upper
0.97
0.000
2.64
1.80
3.87
-0.90
0.000
0.41
0.27
0.61
0.73
0.000
2.06
1.42
3.01
0.91
0.000
2.49
1.50
4.13
Variables in Equation: Study population, Age,, Marital Status, Education, Legal status, Employment, All Mental diseases, All substance abuse, All Somatic Dis., Chemical Exposure, Non-Chemical Exposure, Stress of life 47
Conclusion â&#x20AC;˘ The results showed that Iraqi who were resident in U.S. (G2) have higher
prevalence rate of all somatic diseases studied
â&#x20AC;˘ Also, two out of mental diseases and substance abuse compared to G1. 48
Conclusions â&#x20AC;˘ In addition, G2 reported worse health than Iraqis who are residents in Iraq
(G1) â&#x20AC;˘ Several risk factors predicted for mental
diseases, somatic disease, substance abuse and self-rated health, 49
Road to Wellbeing â&#x20AC;˘ The results could help the policy maker to improve the wellbeing of Iraq in general and those who are still residents in Iraq in particular especially if the government considers rebuilding of health and educational system in particular and all the other infrastructure of the country. 50