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Ezema A, Caputo M, Semaan A, Benova L, Liang ST, Hirschhorn LR. Stress and safety of maternal and newborn healthcare workers early in the COVID-19 pandemic: a repeat cross-sectional analysis from a global online survey from March 2020 to March 2021. BMJ Open 2023; 13:e072155. [PMID: 37640461 PMCID: PMC10462945 DOI: 10.1136/bmjopen-2023-072155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 08/08/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES This study aims to characterise the physical and psychological well-being of maternal and newborn healthcare workers (MNHCWs) during the COVID-19 pandemic. DESIGN Observational repeated cross-sectional study. SETTING An online questionnaire was distributed to MNHCWs around the globe in three separate rounds from March 2020 to March 2021. PARTICIPANTS Total samples of N=1357 (round 1) and N=420 (round 3) primarily consisted of doctors, midwives and nurses in maternal and newborn specialties. Samples represented all WHO regions, with 33% (round 1) and 42% (round 3) from low- or middle-income countries (LMICs). PRIMARY AND SECONDARY OUTCOME MEASURES Responses from rounds 1 (March-June 2020) and 3 (December 2020-March 2021) were analysed to measure self-reported levels of relative stress and workplace protection from COVID-19, while associated factors were determined through multivariable ordinal logistic regression. RESULTS In round 1, 90% of MNHCWs reported increased stress levels and 45% reported insufficient personal protective equipment (PPE) access. Nurses and physicians were less likely to report increased stress than midwives at the pandemic onset. Factors associated with increased stress included being female, being from an LMIC and insufficient PPE. In round 3, 75% reported similar or increased stress while 10% reported insufficient PPE. In both rounds, over 50% of MNHCWs felt relatively or completely unprotected from COVID-19 in the workplace. Those from LMICs were more likely to report feeling unprotected, while receiving organisational information that valued safety was associated with better feelings of protection in the workplace. CONCLUSIONS Among our international sample of MNHCWs, we observed high rates of self-reported stress increase at the start of the pandemic with persistence or increase up to a year later. High rates of feeling unprotected persisted even as PPE became more available. These results may inform interventions needed to support and protect MNHCWs during this and future pandemics.
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Affiliation(s)
- Ashley Ezema
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Matthew Caputo
- Robert J Havey, MD Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Aline Semaan
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Shu-Ting Liang
- Robert J Havey, MD Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lisa R Hirschhorn
- Robert J Havey, MD Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Ohiomoba RO, Owuor PM, Orero W, Were I, Sawo F, Ezema A, Jackson-Gibson M, Hirschhorn LR. Pre-Exposure Prophylaxis (PrEP) Initiation and Retention Among Young Kenyan Women. AIDS Behav 2022; 26:2376-2386. [PMID: 35061115 DOI: 10.1007/s10461-022-03576-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2021] [Indexed: 11/26/2022]
Abstract
The DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, Safe) Initiative works to reduce HIV infection among adolescent girls and young women (AGYW) through prevention interventions including Pre-Exposure Prophylaxis (PrEP). Pamoja CBO in Kisumu, Kenya implemented DREAMS. We describe PrEP initiation and persistence in 549 AGYW who started PrEP through Pamoja and factors associated with discontinuation. Median persistence time was 308 days (95% CI 245, 382) with 59% of AGYW discontinuing by the end of the study. The most common reasons for stopping PrEP were lack of perceived risk (27.9%) and relocation (18.7%). In the multivariable model, only age < 18 was associated with stopping PrEP. Younger age was associated with shorter time to discontinuation. Implementing PrEP through DREAMS was successful in supporting initiation of PrEP for AGYW. However, low rates of persistence at 1 year emphasizes the need for strategies to support PrEP persistence if HIV elimination is to be achieved.
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Affiliation(s)
- Ramael O Ohiomoba
- Feinberg School of Medicine, Northwestern University, Chicago, USA.
- , 175 East Delaware, Apt. 8708, Chicago, IL, 60611, USA.
| | - Patrick Mbullo Owuor
- Department of Anthropology, Northwestern University, Evanston, USA
- Pamoja CBO, Kisumu, Kenya
| | | | | | | | - Ashley Ezema
- Feinberg School of Medicine, Northwestern University, Chicago, USA
| | | | - Lisa R Hirschhorn
- Department of Medical Social Science, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Institute of Global Health, Northwestern University, Chicago, USA
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Hasty GT, Argaw S, Wu T, Harap R, Ohiomoba R, Youmans Q, Ezema A, Akanyirige P, Jackson K, Mandieka E, Pawale A, Pham DT, Tibrewala A, Bryant A, Wilcox J, Okwuosa I. Long-term Survival And Factors Associated With Chronic Kidney Disease Requiring Dialysis Post Orthotopic Heart Transplantation. J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Jackson KC, Youmans QR, Wu T, Harap R, Anderson AS, Chicos A, Ezema A, Mandieka E, Ohiomoba R, Pawale A, Pham DT, Russell S, Sporn PHS, Yancy CW, Okwuosa IS. Heart transplantation outcomes in cardiac sarcoidosis. J Heart Lung Transplant 2021; 41:113-122. [PMID: 34756511 DOI: 10.1016/j.healun.2021.08.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 08/06/2021] [Accepted: 08/18/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Cardiac sarcoidosis (CS) is a progressive inflammatory cardiomyopathy that can lead to heart failure, arrhythmia, and death. There is limited data on Orthotopic Heart Transplantation (OHT) outcomes in patients with CS. Here we examine outcomes in patients with CS who have undergone OHT at centers throughout the United States from 1987 to 2019. METHODS This was an analysis of 63,947 adult patients undergoing OHT captured in the United Network for Organ Sharing (UNOS) registry. Patients were characterized as cardiac sarcoidosis (CS) or Non-CS. Baseline characteristics were compared using chi-square and Kruskal-Wallis Tests. Outcomes of interest included primary graft failure, patient survival, treated graft rejection, hospitalization for infection, and post-transplant malignancy. RESULTS During the study period 227 patients with CS underwent OHT. Patients with CS were younger, had higher proportion of non-white patients, and received transplants at more urgent statuses. After multivariable modeling there was no difference in survival (HR 0.86, CI 0.59-1.3, p = 0.446) or graft failure (HR 0.849, CI 0.58-1.23, p = 0.394) between patients with CS and Non-CS. Patients with CS had lower odds of rejection (OR 0.558, CI 0.315- 0.985, p = 0.0444). Patients with CS had similar odds of hospitalization for infection and post-transplant malignancy, as Non-CS patients. CONCLUSIONS Patients with CS and Non-CS had similar post OHT survival, odds of graft failure, hospitalizations for infection, and post-transplant malignancy. Results of this study confirm the role of heart transplantation as a viable option for patients with CS.
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Affiliation(s)
- K C Jackson
- Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Q R Youmans
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - T Wu
- Department of Cardiac Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - R Harap
- Department of Cardiac Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - A S Anderson
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - A Chicos
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - A Ezema
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - E Mandieka
- Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - R Ohiomoba
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - A Pawale
- Department of Cardiac Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - D T Pham
- Department of Cardiac Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - S Russell
- Division of Pulmonary and Critical Care Medicine, Northwestern University, Feinberg School of Medicine
| | - P H S Sporn
- Division of Pulmonary and Critical Care Medicine, Northwestern University, Feinberg School of Medicine
| | - C W Yancy
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Ike S Okwuosa
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
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Ohiomoba RO, Youmans QR, Ezema A, Akanyirige P, Anderson AS, Bryant A, Jackson K, Mandieka E, Pham DT, Rich JD, Yancy CW, Okwuosa IS. Cardiac transplantation outcomes in patients with amyloid cardiomyopathy. Am Heart J 2021; 236:13-21. [PMID: 33621542 DOI: 10.1016/j.ahj.2021.02.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 02/16/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Amyloid cardiomyopathy (ACM) is a progressive and life-threatening disease caused by abnormal protein deposits within cardiac tissue. The most common forms of ACM are caused by immunoglobulin derived light chains (AL) and transthyretin (TTR). Orthotopic heart transplantation (OHT) remains the definitive treatment for patients with end stage heart failure. In this study, we perform a contemporary multicenter analysis evaluating post OHT survival in patients with ACM. METHODS We conducted a multicenter analysis of 40,044 adult OHT recipients captured in the United Network for Organ Sharing (UNOS) registry from 1987-2018. Patients were characterized as ACM or non-ACM. Baseline characteristics were obtained, and summary characteristics were calculated. Outcomes of interest included post-transplant survival, infection, treated rejection, and the ability to return to work. Racial differences in OHT survival were also analyzed. Unadjusted associations between ACM and non-ACM survival were determined using the Kaplan-Meier estimations and confounding was addressed using multivariable Cox proportional hazards models. RESULTS Three hundred ninety-eight patients with a diagnosis of ACM were identified of which 313 underwent heart only OHT. ACM patients were older (61 vs 53; P < .0001) and had a higher proportion of African Americans (30.7% vs 17.6%; P < .0001). Median survival for ACM was 10.2 years vs 12.5 years in non-ACM (P = .01). After adjusting for confounding, ACM patients had a higher likelihood of death post-OHT (HR 1.39 CI: 1.14, 1.70; P = .001). African American ACM patients had a higher likelihood of survival compared to White ACM patients (HR 0.51 CI 0.31-0.85; P = .01). No difference was observed in episodes of treated rejection (OR 0.63 CI 0.23, 1.78; P = .39), hospitalizations for infections (OR 1.24 CI: 0.85, 1.81; P = .26), or likelihood of returning to work for income (OR 1.23 CI: 0.84, 1.80; P = .30). CONCLUSIONS In this analysis of OHT in ACM, ACM was associated with a higher likelihood of post-OHT mortality. Racial differences in post-OHT were observed with African American patients with ACM having higher likelihood of survival compared to White patients with ACM. No differences were observed in episodes of treated rejection, hospitalization for infection, or likelihood to return to work for income.
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Affiliation(s)
| | | | - Ashley Ezema
- Northwestern University, Feinberg School of Medicine
| | - P Akanyirige
- Northwestern University, Feinberg School of Medicine
| | | | | | | | | | - Duc T Pham
- Northwestern University, Department of Cardiac Surgery
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Akanyirige P, Ezema A, Boakye E, Bryant A, Jackson K, Mandieka E, Ohiomoba R, Princewill O, Youmans Q, Blaha M, Blumenthal R, Lewis A, Okwuosa I. CARDIOVASCULAR RISK PROFILES IN MARIJUANA SMOKERS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03011-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bryant AD, Wu T, Harap R, Akanyirige P, Ezema A, Ghafourian K, Jackson K, Mandieka E, Ohiomoba R, Pawale A, Pham DT, Youmans QR, Okwuosa IS. Pulmonary Hypertension and its Association with Cardiac Transplant Outcomes: Does PA Systolic Matter? J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.09.446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ohiomoba R, Ezema A, Youmans QR, Anderson AS, Jackson K, Mandieka E, Pham DT, Rich JD, Yancy CW, Okwuosa IS. Cardiac Transplantation Outcomes in Patients with Amyloid Cardiomyopathy. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Mandieka E, Zhou A, Harap R, Anderson AS, Ezema A, Jackson K, Ohiomoba R, Pham DT, Rich JD, Yancy CW, Youmans QR, Okwuosa IS. Bridging Strategies and their Association with Post Heart Transplant Outcomes. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ohiomoba R, Youmans QR, Ezema A, Anderson AS, Jackson K, Mandieka E, Pham DT, Rich JD, Yancy CW, Okwuosa IS. History of Cigarette Smoking and Heart Transplant Outcomes. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bowie JV, Bell CN, Ewing A, Kinlock B, Ezema A, Thorpe RJ, LaVeist TA. Religious Coping and Types and Sources of Information Used in Making Prostate Cancer Treatment Decisions. Am J Mens Health 2017; 11:1237-1246. [PMID: 28193130 PMCID: PMC5675355 DOI: 10.1177/1557988317690977] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 10/26/2016] [Accepted: 12/19/2016] [Indexed: 11/17/2022] Open
Abstract
Treatment experiences for prostate cancer survivors can be challenging and dependent on many clinical and psychosocial factors. One area that is less understood is the information needs and sources men utilize. Among these is the influence of religion as a valid typology and the value it may have on treatment decisions. The objective of this study was to assess the relationship between race, religion, and cancer treatment decisions in African American men compared with White men. Data were from the Diagnosis and Decisions in Prostate Cancer Treatment Outcomes Study that consisted of 877 African American and White men. The main dependent variables sought respondents' use of resources or advisors when making treatment decisions. Questions also assessed men perceptions of prostate cancer from the perspective of religious coping. After adjusting for age, marital status, education, and insurance status, race differences in the number of sources utilized were partially mediated by cancer was a punishment from God (β = -0.46, SE = 0.012, p < .001), cancer was a test of faith (β = -0.49, SE = 0.013, p < .001), and cancer can be cured with enough prayer (β = -0.47, SE = 0.013, p < .001). Similarly, race differences in the number of advisors utilized in making the treatment decision were partially mediated by cancer was a punishment from God (β = -0.39, SE = 0.014, p = .006), and cancer was a test of faith (β = -0.39, SE = 0.014, p = .006). Religious views on prostate cancer may play an important role in explaining race differences in information used and the number of advisors utilized for treatment decision making for prostate cancer.
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Affiliation(s)
| | | | | | | | | | | | - Thomas A. LaVeist
- Johns Hopkins University, Baltimore, MD, USA
- George Washington University, Washington, DC, USA
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Abstract
BACKGROUND Cigarette smoking poses a major public health problem that disproportionately affects Blacks and men. Religious attendance has been shown to be positively associated with health promotion and disease prevention among the Black population. In light of this evidence, this study examined if a similar relationship could be found for religious attendance and smoking in Black men. METHODS The National Survey of American Life (NSAL) study sampled 1,271 African American men and 562 Black Caribbean men. Multivariate logistic regression was used to determine the association between religious attendance and cigarette smoking. RESULTS After adjusting for age, marital status, household income, education, foreign born status, importance of prayer and major stress, men who reported attending religious services almost every day (odds ratio (OR) = 0.21, 95% confidence interval (CI) = 0.07, 0.62) and weekly (OR = 0.47, 95% CI = 0.29, 0.77) had lower odds of being a current smoker compared to men who reported never attending religious services. Conclusions/Importance: Findings suggest a health benefit in attending religious services on cigarette smoking among Black men in a nationally representative sample. In spite of lower church attendance in Black men in general, our results demonstrate that religious service attendance may still serve as a buffer against cigarette use. Given the emergent attention on faith-based health promotion among men, this conclusion is relevant and timely.
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Affiliation(s)
- Janice V Bowie
- a Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.,b Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Lauren J Parker
- a Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.,b Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Michelle Beadle-Holder
- a Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.,c Department of Sociology , University of Maryland , College Park , Maryland , USA
| | - Ashley Ezema
- a Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.,d Undergraduate Program in Public Health Studies, Johns Hopkins University , Baltimore , Maryland , USA
| | - Marino A Bruce
- e Center for Health of Minority Males, University of Mississippi Medical Center , Jackson , Mississippi , USA.,f Department of Sociology and Criminal Justice , Jackson State University , Jackson , Mississippi , USA
| | - Roland J Thorpe
- a Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.,b Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.,d Undergraduate Program in Public Health Studies, Johns Hopkins University , Baltimore , Maryland , USA.,g Center for Biobehavioral Health Disparities Research, Duke University , Durham , North Carolina , USA
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