1
|
Akhiwu TO, Adewunmi C, Bilalaga M, Atarere JO, Gaddipati G, Chido-Amajuoyi OG, Eziuche DK, Onyeaka H, Amonoo HL. Clinical trial knowledge among cancer survivors in the United States: the role of health information technology. Cancer Causes Control 2024:10.1007/s10552-024-01928-7. [PMID: 39379678 DOI: 10.1007/s10552-024-01928-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 10/02/2024] [Indexed: 10/10/2024]
Abstract
PURPOSE Clinical trials are essential to the advancement of cancer care. However, clinical trial knowledge and participation remain critically low among adult patients with cancer. Health information technology (HIT) could play an important role in improving clinical trial knowledge and engagement among cancer survivors. METHODS We used data from 3,794 adults who completed the 2020 Health Information National Trends Survey, 626 (16.2%) of whom were cancer survivors. We examined the prevalence of HIT use in the study population and by cancer history using chi-squared tests. We used multivariable logistic regression models to examine the impact of HIT use on clinical trial knowledge for cancer survivors and respondents with no cancer history, respectively. RESULTS Approximately 63.8% of cancer survivors reported having some knowledge of clinical trials. Almost half of the cancer survivors used HIT to communicate with doctors (47.1%) and make health appointments (49.4%), 68.0% used HIT to look up health information online and 42.2% used it to check test results. In the adjusted models, the use of HIT in communicating with doctors [OR 2.79; 95% CI (1.41, 5.54)], looking up health information online [OR 2.84; 95% CI (1.04, 7.77)], and checking test results [OR 2.47; 95% CI (1.12, 5.43)] was associated with having some knowledge of clinical trials. CONCLUSION HIT use for engaging with the healthcare team and health information gathering is associated with higher clinical trial knowledge in cancer survivors. Given the rapid increase in mobile technology access globally and the increased use of HIT, digital technology can be leveraged to improve clinical trial knowledge and engagement among cancer survivors.
Collapse
Affiliation(s)
- Ted O Akhiwu
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA.
- MedStar Health Internal Medicine Residency Program, 201 E University Parkway, Baltimore, MD, 21218, USA.
| | - Comfort Adewunmi
- Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, GA, USA
| | - Mariah Bilalaga
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Joseph O Atarere
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Greeshma Gaddipati
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | | | - Diamond K Eziuche
- Department of Public Health, National Open University, Abuja, Nigeria
| | - Henry Onyeaka
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Hermioni L Amonoo
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| |
Collapse
|
2
|
Smith A, Kindratt TB. Health Information Technology Use among Foreign-Born Adults of Middle Eastern and North African Descent in the United States. J Immigr Minor Health 2024:10.1007/s10903-024-01617-2. [PMID: 38972028 DOI: 10.1007/s10903-024-01617-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2024] [Indexed: 07/08/2024]
Abstract
Health information technology (HIT) use among foreign-born adults of Middle Eastern and North African (MENA) descent is understudied. MENA Americans are currently categorized as "White" in the United States (US) on federal forms. Our purpose was to uncover the prevalence of HIT use among MENA immigrants compared to US- and foreign-born White adults before and after adjusting for covariates. The 2011-2018 National Health Interview Survey data (n = 161,613; ages 18 + years) were analyzed. HIT uses evaluated were searching for health information, filling prescriptions, scheduling appointments, and communicating with healthcare providers via email (last 12 months). Crude and multivariable logistic regression models were used to estimate the odds of each HIT use (searching for health information, filling prescriptions, scheduling appointments, and/or communicating with healthcare providers via email), and overall use of any HIT before and after adjustment. The most common HIT use was looking up health information (46.4% foreign-born MENA, 47.8% foreign-born White, 51.2% US-born White; p = .0079). Foreign-born adults of MENA descent had lower odds (OR = 0.64; 95% CI = 0.56-0.74) of reporting any HIT use, but no difference in reporting all HIT uses compared to US-born White adults. This is the first study to explore HIT use among MENA Americans. Results contribute to growing body of literature showing the health of MENA Americans differs from White Americans. A separate racial/ethnic identifier is needed to better capture HIT uses among populations of MENA descent.
Collapse
Affiliation(s)
- Alexandra Smith
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX, USA
| | - Tiffany B Kindratt
- Department of Kinesiology, Public Health Program, University of Texas at Arlington, Arlington, TX, 76019-0259, USA.
| |
Collapse
|
3
|
Atarere J, Chido-Amajuoyi O, Mensah B, Onyeaka H, Adewunmi C, Umoren M, Mele AA, Kanth P. Primary Care Telehealth Visits and Its Association with Provider Discussion on Colorectal Cancer Screening in the United States. Telemed J E Health 2024; 30:1325-1329. [PMID: 38265693 DOI: 10.1089/tmj.2023.0605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
Background: Provider discussions about colorectal cancer (CRC) screening are the single most important predictor for CRC screening uptake. Methods: Using cross-sectional data from the 2022 Health Information National Trends Survey, we evaluated the relationship between telehealth use and provider discussion about CRC screening with a multivariable logistic regression model. Results: Of adults aged 45-75 years, 20.3% used telehealth services in the past year of which 69.5% had discussed CRC screening with their providers. There was no difference in provider discussion about CRC screening between telehealth users and nonusers (OR 1.26; 95% confidence interval 0.83-1.90). Conclusion: Telehealth is an important adjunct in health care delivery, enhancing patient-provider discussions about CRC screening.
Collapse
Affiliation(s)
- Joseph Atarere
- Department of Medicine, MedStar Health, Baltimore, Maryland, USA
| | - Onyema Chido-Amajuoyi
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Boniface Mensah
- Department of Medicine, MedStar Health, Baltimore, Maryland, USA
| | - Henry Onyeaka
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Comfort Adewunmi
- Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mfoniso Umoren
- Division of Gastroenterology, Georgetown University, Washington DC, USA
| | | | - Priyanka Kanth
- Division of Gastroenterology, Georgetown University, Washington DC, USA
| |
Collapse
|
4
|
Atarere J, Haas C, Onyeaka H, Adewunmi C, Delungahawatta T, Orhurhu V, Barrow J. The Role of Health Information Technology on Colorectal Cancer Screening Participation Among Smokers In The United States. Telemed J E Health 2024; 30:448-456. [PMID: 37486725 DOI: 10.1089/tmj.2023.0052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Background: Despite advances in its prevention and early detection, colorectal cancer (CRC) remains a leading cause of morbidity and mortality in the United States and smokers are at an increased risk. Health information technology (HIT) has shown promise in the uptake of preventive health services, including CRC, and may prove useful among smokers. Methods: We obtained data from 7,419 adults who completed the 2018-2020 Health Information National Trends Survey. Using multivariable logistic regression models, we examined the relationship between HIT use and CRC screening participation. Results: Over 20% of current smokers had no access to HIT tools, and those with access were less likely than never smokers to use HIT in checking test results (odds ratio [OR] 0.58; 95% confidence interval [CI] [0.42-0.80]). Among former smokers, using HIT to check test results (OR 3.41; 95% CI [1.86-6.25]), look up health information online (OR 2.20; 95% CI [1.15-4.22]), and make health appointments (OR 2.86; 95% CI [1.39-5.89]) was associated with increased participation in CRC screening. Among current smokers, the use of HIT was not associated with a change in CRC screening participation. Conclusion: HIT use is associated with higher levels of CRC screening among former smokers, which is reassuring given their increased risk of CRC. The low ownership and use of HIT among current smokers of CRC screening age presents a challenge that may limit the integration of HIT into routine CRC screening services.
Collapse
Affiliation(s)
- Joseph Atarere
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
- Department of Biostatistics and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Christopher Haas
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Henry Onyeaka
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Comfort Adewunmi
- Department of Medicine, Northeast Georgia Medical Center, Gainesville, Georgia, USA
| | | | - Vwaire Orhurhu
- Department of Anesthesiology, University of Pittsburgh Medical Center, Williamsport, Pennsylvania, USA
| | - Jasmine Barrow
- Division of Gastroenterology, MedStar Franklin Square Medical Center, Baltimore, Maryland, USA
| |
Collapse
|
5
|
Allihien SM, Ibrahim S, Markson F, Agyeman WY, Fugar S, Kesiena O. The impact of comorbidities and sociodemographic predictors on pneumococcal vaccination coverage in adults with coronary heart disease. Future Cardiol 2024; 20:11-19. [PMID: 38112281 DOI: 10.2217/fca-2023-0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/10/2023] [Indexed: 12/21/2023] Open
Abstract
Aim: Coronary heart disease (CHD) increases the risk of adverse outcomes from invasive pneumococcal disease. Methods: Using the 2020 and 2021 data from the national health interview survey, we identified adults with CHD. Chi-square analysis and logistic regression were used to examine factors that influence vaccination status. Results: There were 2675 participants aged 41 and above with CHD. Participants were predominantly white people (82.5%) and males (60.1%). The odds of receiving the pneumococcal vaccine increased with stepwise increase in comorbidities from 1 to 2 and from 2 to 3. Among individuals with ≥2 comorbidities, black people were less likely to be vaccinated compared with white people. Conclusion: Pneumococcal vaccine uptake among adults with CHD is determined by cumulative comorbidities and ethnicity.
Collapse
Affiliation(s)
- Saint-Martin Allihien
- Department of Internal Medicine, Piedmont Athens Regional Medical Center, Athens, GA 30606, USA
| | - Sammudeen Ibrahim
- Department of Internal Medicine, Piedmont Athens Regional Medical Center, Athens, GA 30606, USA
| | - Favour Markson
- Department of Internal Medicine, Lincoln Medical Center, 234 E 149 St Bronx, NY 10451, USA
| | - Walter Y Agyeman
- Department of Internal Medicine, Piedmont Athens Regional Medical Center, Athens, GA 30606, USA
| | - Setri Fugar
- Interventional Cardiology, Medical College of Wisconsin, Milwaukee, 8701 Watertown Plank Rd., 5th Floor Milwaukee, WI 53226, USA
| | - Onoriode Kesiena
- Department of Internal Medicine, Piedmont Athens Regional Medical Center, Athens, GA 30606, USA
| |
Collapse
|
6
|
Atarere JO, Onyeaka HK, Chido-Amajuoyi OG, Adewunmi C, Nwaneki C, Dosunmu GT, Faith CO, Amonoo HL. Social media use and health promotion among cancer survivors. Psychooncology 2024; 33:e6299. [PMID: 38282227 DOI: 10.1002/pon.6299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/18/2023] [Accepted: 01/14/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVE Social media is becoming recognized as an effective platform for cancer health promotion, education, care, and support. However, its utility as a health promotion tool remains relatively unexplored. METHODS Using cross-sectional data from the 2017-2020 Health Information National Trends Survey, we evaluated health-related usage of social media among cancer survivors and individuals without a history of cancer. We also examined the participant characteristics associated with social media usage and evaluated the relationship between social media use and positive health behaviors among the cancer survivors. RESULTS Overall, cancer survivors (n = 2579) were as likely as individuals without a history of cancer to use social media for health promotion. Males [OR 0.65; 95% CI (0.45, 0.93)] and older adults (>60 years old) [OR 0.27; 95% CI(0.10, 0.77)] were less likely to use social media, while higher income [OR 2.27; 95% CI (1.05, 4.92) middle income; OR 1.90; 95% CI (1.17, 3.09) high income] and educational levels [OR 3.29; 95% CI (1.85, 5.84) some college; OR 2.36; 95% CI (1.30, 4.28) college graduate or more] were associated with more health-related social media use among survivors. Cancer survivors used social media for online support groups more than other individuals, and those who used at least one form of social media for health-related purposes increasingly meet national recommendations for strength training compared to non-users [OR 2.15; 95% CI (1.48, 3.13)]. CONCLUSIONS Our findings demonstrate the potential utility of social media to promote positive health behaviors among cancer survivors. Further research is needed to describe the efficacy of social media-based interventions for improving health behaviors in diverse cancer populations.
Collapse
Affiliation(s)
- Joseph O Atarere
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Henry K Onyeaka
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Onyema G Chido-Amajuoyi
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Comfort Adewunmi
- Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chisom Nwaneki
- Department of Medicine, Saint Peter's University Hospital, New Brunswick, New Jersey, USA
| | - Gideon T Dosunmu
- Department of Hematology and Oncology, University of Chicago, Chicago, Illinois, USA
| | - Chilotam O Faith
- Department of Medical and Laboratory Sciences, Madonna University, Madonna, Nigeria
| | - Hermioni L Amonoo
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychosocial Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
7
|
Smith A, Kindratt T. Health information technology use among foreign-born adults of Middle Eastern and North African decent in the United States. RESEARCH SQUARE 2023:rs.3.rs-3491745. [PMID: 37961100 PMCID: PMC10635357 DOI: 10.21203/rs.3.rs-3491745/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Health information technology (HIT) use among foreign-born adults of Middle Eastern and North African (MENA) descent living in America is an understudied population. They are currently categorized as "White" in the United States (US) on federal forms. The purpose was to uncover the prevalence of HIT use among MENA immigrants compared to US- and foreign-born White adults before and after adjusting for other factors. The 2011-2018 National Health Interview Survey data (n = 161,613; ages 18 + years) was analyzed. HIT uses evaluated were searching for health information, filling prescriptions, scheduling appointments, and communicating with healthcare providers via email (last 12 months). Crude and multivariable logistic regression models were used to estimate the odds of each HIT use, any HIT use, and all HIT uses before and after adjustment. The most common HIT use was looking up health information, with 46.4% of foreign-born adults of MENA, 47.8% of foreign-born White, and 51.2% of US-born White adults reporting its use (p = .0079). Foreign-born adults of MENA descent had lower odds (OR = 0.64; 95%CI = 0.56-0.74) of reporting any HIT use, but no difference in reporting all HIT uses compared to US-born White adults in adjusted models. This is the first study to explore HIT use among Americans of MENA descent. Patterns of HIT use among adults of MENA descent differ from White adults. Results contribute to growing body of literature showing the health of Americans of MENA descent differs from White Americans. A separate racial/ethnic identifier is needed to better capture HIT uses among populations of MENA descent.
Collapse
|
8
|
Onyeaka HK, Muoghalu C, Deary EC, Ajayi KV, Kyeremeh E, Dosunmu TG, Jawla M, Onaku E, Nwani SP, Asante KO, Amonoo HL. The Role of Health Information Technology in Improving Awareness of Human Papillomavirus and Human Papillomavirus Vaccine Among U.S. Adults. Telemed J E Health 2023; 29:886-895. [PMID: 36394492 PMCID: PMC10277992 DOI: 10.1089/tmj.2022.0381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/17/2022] [Accepted: 09/22/2022] [Indexed: 11/19/2022] Open
Abstract
Objective: Although human papillomavirus (HPV) vaccines prevent cancer-causing HPV infections and cervical precancers, there is suboptimal awareness and limited global accessibility of HPV and HPV vaccine. Emerging evidence suggests that health information technology (HIT) may influence HPV-related awareness and improve vaccine adoption. The objective of this study was to evaluate the link between HIT and HPV-related awareness Methods: Data were obtained from 1,866 U.S. adults aged 18-45 years who completed the 2017 and 2018 Health Information National Trends Survey. We conducted multivariable logistic regression to analyze the association between HIT utilization and HPV-related awareness. Results: Awareness of HPV and HPV vaccine were 72.7% and 67.5%, respectively. Participants who used electronic means to look up health information (adjusted odds ratio [aOR] = 3.05; p = 0.001), communicate with health care provider (aOR = 1.68; p = 0.026), look up test results (aOR = 1.94; p = 0.005), and track health costs (aOR = 1.65; p = 0.04) were more likely to report HPV awareness than those who did not. Participants who used an electronic device to look up health information (aOR = 3.10; p = 0.003), communicate with clinicians (aOR = 1.72; p = 0.008), look up test results (aOR = 1.63; p = 0.021), and track health care charges (aOR = 1.90; p = 0.006) were more likely to report HPV vaccine awareness than those who did not. Discussion and Conclusion: Our findings suggest a positive association between HIT utilization and HPV-related awareness. Given the rapid and exponential increase in mobile technology access globally, these results are encouraging and offer a potential opportunity to leverage digital technology in primary cancer prevention for HPV-related cancers, especially in low- and middle-income countries with unsophisticated health infrastructures.
Collapse
Affiliation(s)
- Henry K. Onyeaka
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Chioma Muoghalu
- Department of Clinical Informatics, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Pediatrics, Presbyterian Hospital, Clovis, New Mexico, USA
| | - Emma C. Deary
- Department of Psychiatry, Brigham and Women Hospital, Boston, Massachusetts, USA
| | - Kobi V. Ajayi
- Department of Health and Kinesiology, Texas A&M University, College Station, Texas, USA
- Laboratory of Community Health Evaluation Science and Systems (CHESS), Texas A&M University, College Station, Texas, USA
| | - Emmanuel Kyeremeh
- Department of Sociology, University of Toronto, Toronto, Ontario, Canada
| | | | - Muhammed Jawla
- Department of Epidemiology, Louisiana State University School of Health Sciences, New Orleans, Louisiana, USA
| | | | - Somtochi P Nwani
- Faculty of Pharmaceutical Sciences, University of Nigeria, Enugu, Nigeria
| | | | - Hermioni L. Amonoo
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Brigham and Women Hospital, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| |
Collapse
|
9
|
Okobi OE, Odoma VA, Ogochukwu OA, Onyeaka CN, Sike CG, Mbaezue RN, Iyare W, Akhani V, Okeke CH, Ojo S, Moevi AA. Assessing the Relationship Between Health Information Technology Use and Self-Rated Health Among Adults with Chronic Low Back Pain in the United States. Cureus 2023; 15:e39469. [PMID: 37362507 PMCID: PMC10290284 DOI: 10.7759/cureus.39469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
OBJECTIVE To assess the use of health information technology (HIT) among adults with chronic low back pain (CLBP) in the United States and to evaluate the relationship between HIT use and self-rated health. METHODS The independent variable was the use of the internet to (1) fill prescriptions, (2) communicate with a healthcare provider, (3) look up health information, and (4) schedule a medical appointment. Respondents rated their health in the last 12 months as worse, about the same, or better. A Chi-square analysis was used to assess the use of HIT among those with CLBP; a logistic regression was used to determine predictors of HIT use; and an ordinal logistic regression was used to assess the relationship between HIT and self-rated health. RESULTS As compared to those without CLBP, those with CLBP are more likely to use the internet to look up health information (58.9 vs. 53.8%, p-value<.001), refill prescriptions (13.9% vs. 10.5%, p-value<.001), and communicate with a healthcare provider (19.8% vs.15.3%, p-value<.001). Being employed and having a higher level of education were positive predictors of HIT use. As compared to other uses of the internet, using the internet to communicate with a healthcare provider was associated with higher odds of rating health as better compared to worse or about the same within the last 12 months. CONCLUSION Among adults with CLBP, a more affluent social status is associated with the use of HIT. Also, HIT is associated with a better health rating as compared to not using it at all. Further studies should assess the longitudinal relationship between HIT use and how adults with CLBP rate their health.
Collapse
Affiliation(s)
- Okelue E Okobi
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | - Victor A Odoma
- Cardiology/Oncology, Indiana University (IU) Health Bloomington Hospital, Bloomington, USA
| | - Okonkwo A Ogochukwu
- Internal Medicine, College of Medicine, Ambrose Alli University, Ekpoma, NGA
| | | | - Cherechi G Sike
- Family Medicine, Windsor University School of Medicine, Cayon, KNA
| | | | - Walter Iyare
- General Medicine, Lugansk State Medical University, Luhansk, UKR
| | - Vaidehi Akhani
- Internal Medicine, Spartan Health Sciences University, Vieux Fort, LCA
| | | | - Soji Ojo
- Psychiatry, University of Texas Health Science Center at Houston, Houston, USA
| | - Adole A Moevi
- Internal Medicine, Avalon University School of Medicine, Willemstad, CUW
| |
Collapse
|