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Shakya S, Stedman-Smith M, White PC, Bhatta MP. Knowledge, Attitudes, Practices, and Prevention Barriers Related to Childhood Lead Poisoning Among Nepali-Speaking Bhutanese Parents in Northeast Ohio, United States. J Immigr Minor Health 2024; 26:351-360. [PMID: 37642886 DOI: 10.1007/s10903-023-01543-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2023] [Indexed: 08/31/2023]
Abstract
The study objectives were: (i) to develop and administer a survey to assess childhood lead poisoning (CLP) knowledge, attitudes, practices and prevention barriers (KAP-B) among the Nepali-Speaking Bhutanese (NSB) community in Northeast Ohio; and (ii) to examine the association between socio-demographic characteristics of NSB parents and their understanding of CLP as measured by the constructs of knowledge and attitudes. A Nepali language KAP-B questionnaire was developed and 200 NSB parents with at least one child ≤ 7 years of age from the Akron Metropolitan Area, Ohio were interviewed. NSB parents demonstrated a low level of knowledge about CLP prevention measures. While 82% lived in pre-1978 houses, only 27.5% perceived their house/neighborhood to be potentially lead contaminated. Only 33% of the parents reported understanding lead-related information provided by their child's healthcare provider. Low-level CLP awareness among NSB community emphasizes a need for culturally tailored and linguistically appropriate community-level CLP educational intervention programs in this vulnerable community.
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Affiliation(s)
- Sunita Shakya
- College of Public Health, Kent State University, P.O. Box 5190, 44242-0001, Kent, OH, USA
| | - Maggie Stedman-Smith
- College of Public Health, Kent State University, P.O. Box 5190, 44242-0001, Kent, OH, USA
| | | | - Madhav P Bhatta
- College of Public Health, Kent State University, P.O. Box 5190, 44242-0001, Kent, OH, USA.
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Yusufi MO, Fanning E, Bhatta MP. Determinants of obstetric fistula in Afghanistan: an analysis of the Demographic and Health Survey 2015. Int J Gynaecol Obstet 2021; 159:213-222. [PMID: 34939195 DOI: 10.1002/ijgo.14080] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/13/2021] [Accepted: 12/21/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Obstetric fistula is a significant but neglected health problem faced by women in the developing world. Epidemiologic studies examining the determinants of obstetric fistula in Afghan women are currently lacking. Therefore, this study examined the reproductive, sociodemographic, and geographic factors associated with obstetric fistula in women in Afghanistan. METHODS This cross-sectional study used data from a nationally representative sample of women collected through the Afghanistan Demographic and Health Survey 2015. Descriptive and binary and multivariable logistic regression analyses were performed to estimate the prevalence of obstetric fistula and describe and assess the risk factors associated with the condition. RESULTS Among the weighted sample of 29,374 women aged 15-49 years, 2.99% reported having an obstetric fistula. In a multivariable logistic regression analysis, factors associated with women reporting a history of an obstetric fistula included parity, ethnicity, geography, income level, educational attainment, employment outside the home, decider on medical care, and their husband's education level. CONCLUSION Our findings highlight the multifactorial nature of the determinants of obstetric fistula in Afghan women and underscore the need for multi-disciplinary integrative interventions to address the reproductive, socioeconomic, cultural, and healthcare related factors in reducing the burden of obstetric fistula in women in Afghanistan.
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Affiliation(s)
| | - Erin Fanning
- College of Public Health, Kent State University Kent, OHIO, USA
| | - Madhav P Bhatta
- College of Public Health, Kent State University Kent, OHIO, USA
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Bhatta MP, Bista S, El Khoury AC, Hutzell EG, Tandon N, Smith D. Long-Acting Injectable Antipsychotic Use in Patients with Schizophrenia and Criminal Justice System Encounters. J Health Econ Outcomes Res 2021; 8:63-70. [PMID: 34056030 PMCID: PMC8137150 DOI: 10.36469/jheor.2021.22979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/29/2021] [Indexed: 06/12/2023]
Abstract
Background: Nonadherence to medication is prevalent in persons diagnosed with schizophrenia, thus increasing the likelihood of relapse, poor health outcomes, hospitalization, high treatment costs, and high rates of both violent and non-violent offenses. Objective: To assess the association between long-acting injectable (LAI) antipsychotic use and criminal justice system encounters in patients with schizophrenia or schizoaffective disorder. Methods: This retrospective follow-up study was conducted among patients aged ≥18 years treated for schizophrenia or schizoaffective disorder at a community mental health center in Akron, Ohio, between January 1, 2010, and June 15, 2016. The incidence of criminal justice system encounters at 6 months, 1 year, and 2 years pre- versus post-LAI antipsychotic initiation was assessed. A subanalysis was conducted for individuals with a history of prior arrest. Results: Overall, the risk ratio (RR) of having an encounter with the criminal justice system was significantly lower for patients treated with LAI antipsychotics 1 year after initiation of treatment compared with a similar time period prior to initiation (RR [95% confidence interval (CI)]: 0.74 [0.59-0.93]; P<0.01) and 2 years (0.74 [0.62-0.88]; P<0.0001). Statistically significant reductions in criminal justice system encounters after treatment than before treatment were observed in the once-monthly paliperidone palmitate (PP1M) cohort. The incidence of arrests was lower in the 6-month (27 vs 85 arrests), 1-year (46 vs 132 arrests) and 2-year (88 vs 196 arrests) periods post-index LAI medication than in the corresponding periods pre-index LAI medication among individuals with a history of prior arrest. Conclusions: Patients with schizophrenia or schizoaffective disorder who were initiated on a LAI antipsychotic medication, specifically PP1M, were less likely to have an encounter with the criminal justice system compared with a similar time period before the initiation of LAI treatment.
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Affiliation(s)
| | - Saroj Bista
- Kent State University College of Public Health, Kent, OH
| | | | - Eric G Hutzell
- County of Summit Alcohol, Drug Addiction, and Mental Health Services Board, Akron, OH
| | | | - Douglas Smith
- County of Summit Alcohol, Drug Addiction, and Mental Health Services Board, Akron, OH
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Abstract
Objectives. To assess the prevalence of and the demographic factors for elevated blood lead level (EBLL; ≥ 5 µg/dL) at resettlement among newly admitted refugee children. Methods. This cross-sectional study used data from the postresettlement refugee medical screening of 5661 children resettled in Ohio from 2009 to 2016. We computed prevalence of EBLL and adjusted prevalence ratio with modified Poisson regression modeling. Results. Overall, 22.3% of children younger than 18 years and 27.1% of those younger than 6 years had an EBLL. Children resettled from a South Asia region including Afghanistan (EBLL prevalence = 56.2%; 95% confidence interval [95% CI] = 48.1%, 64.3%), Nepal (44.0%; 95% CI = 33.7%, 54.1%), Bhutan (32.8%; 95% CI = 30.4%, 35.9%), and Burma (31.8%; 95% CI = 27.5%, 35.9%) had the highest prevalence of EBLLs. In addition, those younger than 6 years (prevalence ratio [PR] = 2.0; 95% CI = 1.6, 2.6), male (PR = 1.3; 95% CI = 1.1, 1.4), and screened within 30 days of arrival (PR = 1.7; 95% CI = 1.1, 2.5) had significantly higher EBLL prevalence than did children aged 13 years and older, female, and screened 90 days after arrival. Conclusions. The overall high proportion of EBLL and variation in EBLL by country of origin among resettled refugee children in the United States warrant comprehensive, yet tailored, guidelines for health professionals and resettlement and government agencies for better prevention and awareness programs targeting these high-risk children.
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Affiliation(s)
- Sunita Shakya
- The authors are with the College of Public Health, Kent State University, Kent, OH
| | - Madhav P Bhatta
- The authors are with the College of Public Health, Kent State University, Kent, OH
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Kingsbury DM, Bhatta MP, Castellani B, Khanal A, Jefferis E, Hallam JS. Factors Associated with the Presence of Strong Social Supports in Bhutanese Refugee Women During Pregnancy. J Immigr Minor Health 2018; 21:837-843. [PMID: 30027506 DOI: 10.1007/s10903-018-0790-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Social support may mitigate stress related to the refugee experience, including during resettlement. For refugee women, social support can play an important role during pregnancy. In-depth interviews were conducted within a sample of 45 Bhutanese refugee women. Perceived social support was measured using the Norbeck Social Support Questionnaire. Averaged social support scores are reported to account for personal network size. Participants were identified as "low support" and "high support" based on their reported score. The mean social support score reported was 18.9. Participants experiencing a secondary resettlement within the U.S. were 4.52 (95% CI 1.19-17.15) times as likely to report a "high support" network compared to participants who resettled directly from Nepal. Personal social networks are an important source of support for resettled refugee women during pregnancy in the U.S.. Refugee women who experience secondary resettlement may perceive stronger support from their personal connections.
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Affiliation(s)
- Diana M Kingsbury
- College of Public Health, Kent State University, Kent, OH, USA. .,Northeast Ohio Medical University, 4209 State Route 44, P.O. Box 95, Rootstown, OH, 44272, USA.
| | - Madhav P Bhatta
- College of Public Health, Kent State University, Kent, OH, USA
| | | | - Aruna Khanal
- College of Public Health, Kent State University, Kent, OH, USA
| | - Eric Jefferis
- College of Public Health, Kent State University, Kent, OH, USA
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M Kingsbury D, P Bhatta M, Castellani B, Khanal A, Jefferis E, S Hallam J. The Personal Social Networks of Resettled Bhutanese Refugees During Pregnancy in the United States: A Social Network Analysis. J Community Health 2018; 43:1028-1036. [PMID: 29696598 DOI: 10.1007/s10900-018-0518-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Women comprise 50% of the refugee population, 25% of whom are of reproductive age. Female refugees are at risk for experiencing significant hardships associated with the refugee experience, including after resettlement. For refugee women, the strength of their personal social networks can play an important role in mitigating the stress of resettlement and can be an influential source of support during specific health events, such as pregnancy. A personal social network analysis was conducted among 45 resettled Bhutanese refugee women who had given birth within the past 2 years in the Akron Metropolitan Area of Northeast Ohio. Data were collected using in-depth interviews conducted in Nepali over a 6-month period in 2016. Size, demographic characteristics of ties, frequency of communication, length of relationship, and strength of connection were the social network measures used to describe the personal networks of participants. A qualitative analysis was also conducted to assess what matters were commonly discussed within networks and how supportive participants perceived their networks to be. Overall, participants reported an average of 3 close personal connections during their pregnancy. The networks were comprised primarily of female family members whom the participant knew prior to resettlement in the U.S. Participants reported their networks as "very close" and perceived their connections to be supportive of them during their pregnancies. These results may be used to guide future research, as well as public health programming, that seeks to improve the pregnancy experiences of resettled refugee women.
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Affiliation(s)
- Diana M Kingsbury
- College of Public Health, Kent State University, Kent, OH, USA. .,Department of Family & Community Medicine, Northeast Ohio Medical University (NEOMED), Rootstown, OH, USA.
| | - Madhav P Bhatta
- College of Public Health, Kent State University, Kent, OH, USA
| | - Brian Castellani
- Department of Sociology, Kent State University, Ashtabula, OH, USA
| | - Aruna Khanal
- College of Public Health, Kent State University, Kent, OH, USA
| | - Eric Jefferis
- College of Public Health, Kent State University, Kent, OH, USA
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Krystosik AR, Curtis A, Buritica P, Ajayakumar J, Squires R, Dávalos D, Pacheco R, Bhatta MP, James MA. Community context and sub-neighborhood scale detail to explain dengue, chikungunya and Zika patterns in Cali, Colombia. PLoS One 2017; 12:e0181208. [PMID: 28767730 PMCID: PMC5540594 DOI: 10.1371/journal.pone.0181208] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 06/27/2017] [Indexed: 02/04/2023] Open
Abstract
Background Cali, Colombia has experienced chikungunya and Zika outbreaks and hypoendemic dengue. Studies have explained Cali’s dengue patterns but lack the sub-neighborhood-scale detail investigated here. Methods Spatial-video geonarratives (SVG) with Ministry of Health officials and Community Health Workers were collected in hotspots, providing perspective on perceptions of why dengue, chikungunya and Zika hotspots exist, impediments to control, and social outcomes. Using spatial video and Google Street View, sub-neighborhood features possibly contributing to incidence were mapped to create risk surfaces, later compared with dengue, chikungunya and Zika case data. Results SVG captured insights in 24 neighborhoods. Trash and water risks in Calipso were mapped using SVG results. Perceived risk factors included proximity to standing water, canals, poverty, invasions, localized violence and military migration. These risks overlapped case density maps and identified areas that are suitable for transmission but are possibly underreporting to the surveillance system. Conclusion Resulting risk maps with local context could be leveraged to increase vector-control efficiency- targeting key areas of environmental risk.
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Affiliation(s)
- Amy R. Krystosik
- Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University, Kent, OH, United States of America
- * E-mail:
| | - Andrew Curtis
- Health & Hazards Lab, Department of Geography, Kent State University, Kent, OH, United States of America
| | - Paola Buritica
- Grupo de Investigación en Epidemiología y Servicios (GRIEPIS), Universidad Libre, Cali, Colombia
| | - Jayakrishnan Ajayakumar
- Health & Hazards Lab, Department of Geography, Kent State University, Kent, OH, United States of America
| | - Robert Squires
- Health & Hazards Lab, Department of Geography, Kent State University, Kent, OH, United States of America
| | - Diana Dávalos
- Department of Public Health and Community Medicine, Universidad ICESI, Cali, Valle del Cauca, Colombia
- Center for Clinical Research, Fundación Valle del Lili (FVL), Cali, Valle del Cauca, Colombia
| | - Robinson Pacheco
- Grupo de Investigación en Epidemiología y Servicios (GRIEPIS), Universidad Libre, Cali, Colombia
- Department of Public Health and Community Medicine, Universidad ICESI, Cali, Valle del Cauca, Colombia
- Center for Clinical Research, Fundación Valle del Lili (FVL), Cali, Valle del Cauca, Colombia
| | - Madhav P. Bhatta
- Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University, Kent, OH, United States of America
| | - Mark A. James
- Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University, Kent, OH, United States of America
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Cheruvu VK, Bhatta MP, Drinkard LN. Factors associated with parental reasons for "no-intent" to vaccinate female adolescents with human papillomavirus vaccine: National Immunization Survey - Teen 2008-2012. BMC Pediatr 2017; 17:52. [PMID: 28193249 PMCID: PMC5307730 DOI: 10.1186/s12887-017-0804-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 02/01/2017] [Indexed: 11/10/2022] Open
Abstract
Background 1) To identify socio-demographic factors associated with parental “no-intent” for their 13–17 year old unvaccinated daughter to receive the human papillomavirus (HPV) vaccine series within the next twelve months, 2) to describe patterns in “no-intent” by socio-demographic factors, and 3) to identify socio-demographic factors associated with parental reasons for “no-intent”. Methods Data from 2008–2012 National Immunization Survey - Teen (NIS - Teen) were examined in this study. Parents with “no-intent” to vaccinate their daughters were asked to identify reasons for their decision. All responses were categorized into five domains identified as barriers to receive the HPV vaccine series: 1) Safety and Effectiveness Concerns; 2) Systemic Barriers; 3) Vaccine Misinformation; 4) Lack of Knowledge about the Vaccine; and 5) Socio-cultural Barriers. Multivariable logistic regression models were performed to address the study objectives. Results Number of people in the household, household income, mother’s age, education, health insurance, recommendation of a health care provider, and the survey year were significantly associated with parental “no-intent”. Race/ethnicity, mother’s education, marital status, recommendation of a health care provider, household income, age of the unvaccinated daughter, and the survey year, were significantly associated with one or more domains identified as barriers to receive the HPV vaccine. Conclusions This study identified sub-groups of parents across different socio-demographic factors with “no-intent” for their adolescent daughters to receive the HPV vaccine. Developing strategies that target educational tools towards the identified sub-groups of parents about the purpose, safety, and efficacy of the HPV vaccine, and HPV infection, may help increase HPV vaccine acceptance, initiation and completion rates.
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Affiliation(s)
- Vinay K Cheruvu
- Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University, Hilltop Drive, 320 Lowry Hall, Kent, 44242, OH, USA.
| | - Madhav P Bhatta
- Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University, Hilltop Drive, 320 Lowry Hall, Kent, 44242, OH, USA
| | - Lauren N Drinkard
- Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University, Hilltop Drive, 320 Lowry Hall, Kent, 44242, OH, USA
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Bhatta MP, Johnson DC, Lama M, Aryal S, Lhaki P, Shrestha S. High-risk human papillomavirus infection and abnormal cervical cytology among Nepali and Bhutanese refugee women living in eastern Nepal. BMC Infect Dis 2017; 17:73. [PMID: 28088173 PMCID: PMC5237500 DOI: 10.1186/s12879-017-2186-2] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/05/2017] [Indexed: 11/27/2022] Open
Abstract
Background Cervical cancer is the leading cause of cancer morbidity and mortality among women in Nepal and Bhutan. Data on high-risk human papillomavirus (HR-HPV) infection and cervical abnormalities among Nepali and Bhutanese women are sparse. The objectives of this study were to assess and compare the prevalence of HR-HPV infection and cervical abnormalities among Nepali and Bhutanese women living in Jhapa District in eastern Nepal; and examine the risk factors for HR-HPV infection and cervical abnormalities in those women. Methods Study participants were recruited from a women’s health camp organized by NFCC-International, a Nepal-based non-governmental organization, in 2014. Consenting participants were administered a demographic and health questionnaire and cervico-vaginal specimens collected. Both self-collected and clinician-collected cervico-vaginal specimens were tested for HR-HPV infection. Cytologic exam was performed on clinician-collected samples and cervical cytology results were categorized according to the Bethesda classification. A participant was classified as a Bhutanese if they were either born in Bhutan or currently lived in one of the United Nations administered Bhutanese refugee camps in Jhapa; otherwise, the participant was classified as a Nepali. Results Of the 647 study participants, 15.9% were Bhutanese women living in refugee camps and the overall age (± standard deviation) was 38.8 ± 8.2 years. The prevalence of HR-HPV infection was 8.9% and abnormal cervical cytology was 7.1% respectively, with no significant difference in HR-HPV positivity (p = 0.399) or abnormal cervical cytology (p = 0.698) between Nepali and Bhutanese women. Compared to women whose husbands had not migrated for employment, women whose husbands had migrated outside of the district had 3.30 times (95% Confidence Interval [CI]: 1.13–9.64) the odds of being HR-HPV positive and women whose husbands had migrated outside the country had 2.92 times (95% CI: 1.32–6.49) the odds of having abnormal cervical cytology. Conclusions HR-HPV positivity and abnormal cervical cytology were similar among Nepali and Bhutanese women. Husbands migrating for employment within or outside the country was a significant risk factor for high-risk HPV infection and cervical cytology, indicating the important role spousal behavior may play in HR-HPV acquisition and cervical abnormalities among these women.
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Affiliation(s)
- Madhav P Bhatta
- Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health Kent State University, PO Box 5190, Kent, OH, 44242, USA.
| | - Derek C Johnson
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | | | - Shilu Aryal
- Family Health Division, Nepal Ministry of Health, Kathmandu, Nepal
| | | | - Sadeep Shrestha
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
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Bhatta MP, Shakya S, Assad L, Zullo MD. Chronic Disease Burden Among Bhutanese Refugee Women Aged 18-65 Years Resettled in Northeast Ohio, United States, 2008-2011. J Immigr Minor Health 2016; 17:1169-76. [PMID: 24849870 DOI: 10.1007/s10903-014-0040-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The purpose of this community-based study was to assess the prevalence of chronic diseases among 18-65 year old Bhutanese refugee women resettled in Northeast Ohio, United States (US). A Nepali-language questionnaire was administered in a face-to-face mode. Anthropometric measurements included height, weight, and hip and waist circumferences. The overall prevalence (95 % confidence interval) of self-reported hypertension, diabetes, asthma, heart disease, and cancer were 15.3 % (9.2-23.4), 6.4 % (2.3-10.9), 5.5 % (2.0-11.5), 2.7 % (0.6-7.8), and 1.8 % (0.2-6.4), respectively. Overweight/obesity was observed in 64.8 % of the women; 69.5 and 74.1 % had waist circumference >80 cm and waist-to-hip ratio ≥85, respectively. Length of time in the US was not associated with the prevalence of the chronic conditions. This study suggests chronic conditions may be significant health issues among US resettled Bhutanese refugees and a larger population-based study to confirm the findings is warranted.
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Affiliation(s)
- Madhav P Bhatta
- Department of Biostatistics, Environmental Health Sciences and Epidemiology, College of Public Health, Kent State University, P. O. Box 5190, Kent, OH, 44242, USA,
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Makowsky R, Lhaki P, Wiener HW, Bhatta MP, Cullen M, Johnson DC, Perry RT, Lama M, Boland JF, Yeager M, Ghimire S, Broker TR, Shrestha S. Genomic diversity and phylogenetic relationships of human papillomavirus 16 (HPV16) in Nepal. Infect Genet Evol 2016; 46:7-11. [PMID: 27725301 DOI: 10.1016/j.meegid.2016.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/05/2016] [Accepted: 10/06/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES/BACKGROUND Sequence variants in HPV16 confer differences in oncogenic potential; however, to date there have not been any HPV sequence studies performed in Nepal. The objective of this study was to characterize HPV16 viral genome sequences from Nepal compared to a reference sequence in order to determine their lineages. Additionally, we sought to determine if five High-grade Squamous Intraepithelial Lesion (HSIL) subjects were genetically distinct from the non-HSIL subjects. METHODS DNA was isolated from exfoliated cervical cells from 17 individuals in Nepal who were previously identified to be HPV16-positive. A custom HPV16 Ion Ampliseq panel of multiplexed degenerate primers was designed that generated 47 overlapping amplicons and covered 99% of the viral genome for all known HPV16 variant lineages. All sequence data were processed through a custom quality control and analysis pipeline of sequence comparisons and phylogenetic analysis. RESULTS There were high similarities across the genomes, with two major indels observed in the non-coding region between E5 and L2. Compared to the PAVE reference HPV16 genome, there were up to 9, 4, 38, 27, 8, 7, 52, and 32 nucleotide variants in the E6, E7, E1, E2, E4, E5, L2, and L1 genes in the Nepalese samples, respectively. Based on sequence variation, HPV16 from Nepal falls across the A, C, and D lineages in this study. We found no evidence of genetic distinctness between HSIL and non-HSIL subjects. CONCLUSIONS The evolutionary and pathological characteristics of the representative HPV16 genomes from Nepal seem similar to results from other parts of the world and provide the basis for further studies.
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Affiliation(s)
- Robert Makowsky
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, AL, USA
| | | | - Howard W Wiener
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, AL, USA
| | - Madhav P Bhatta
- Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University, OH, USA
| | - Michael Cullen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA; Cancer Genomics Research Laboratory, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc., Gaithersburg, MD, USA
| | - Derek C Johnson
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, AL, USA
| | - Rodney T Perry
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, AL, USA
| | | | - Joseph F Boland
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA; Cancer Genomics Research Laboratory, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc., Gaithersburg, MD, USA
| | - Meredith Yeager
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA; Cancer Genomics Research Laboratory, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc., Gaithersburg, MD, USA
| | - Sarita Ghimire
- Cancer Screening Center, Nepal Cancer Care Foundation, Lalitpur, Nepal
| | - Thomas R Broker
- Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sadeep Shrestha
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, AL, USA.
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Johnson DC, Lhaki P, Bhatta MP, Kempf MC, Smith JS, Bhattarai P, Aryal S, Chamot E, Regmi K, Vermund SH, Shrestha S. Spousal migration and human papillomavirus infection among women in rural western Nepal. Int Health 2016; 8:261-8. [PMID: 27048288 DOI: 10.1093/inthealth/ihw015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 08/13/2015] [Accepted: 01/12/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In April 2014 we investigated the association of migration of a woman's husband with her high-risk human papillomavirus (HR-HPV) infection status and her abnormal cervical cytology status in the Achham district of rural Far-Western Nepal. METHODS Women were surveyed and screened for HR-HPV during a health camp conducted by the Nepal Fertility Care Center. Univariate and multivariable statistical tests were performed to determine the association of a husband's migration status with HR-HPV infection and cervical cytology status. RESULTS In 265 women, the prevalence of HR-HPV was 7.5% (20/265), while the prevalence of abnormal cervical cytology, defined using the Bethesda system as atypical glandular cells of undetermined significance or worse, was 7.6% (19/251). Half of the study participants (50.8%, 130/256) had husbands who had reported migrating for work at least once. Women aged ≤34 years were significantly less likely to test positive for HR-HPV than women aged >34 years (OR 0.22, 95% CI 0.07 to 0.71). HR-HPV infection and abnormal cervical cytology status were not directly associated with a husband's migration. CONCLUSION Older women were found to have a higher prevalence of HPV than younger women. It is possible that a husband's migration for work could be delaying HR-HPV infections in married women until an older age.
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Affiliation(s)
- Derek C Johnson
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pema Lhaki
- NFCC/NFCC International, Kathmandu, Nepal
| | - Madhav P Bhatta
- College of Public Health, Kent State University, Kent, OH, USA
| | - Mirjam-Colette Kempf
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA Department of Health Behavior, University of Alabama at Birmingham, AL, USA
| | - Jennifer S Smith
- Department of Epidemiology, University of North Carolina, Chapel Hill, USA
| | | | - Shilu Aryal
- Nepal Family Health Division, Kathmandu, Nepal
| | - Eric Chamot
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kiran Regmi
- Nepal Family Health Division, Kathmandu, Nepal
| | - Sten H Vermund
- Vanderbilt Institute for Global Health and Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Sadeep Shrestha
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
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Mboane R, Bhatta MP. Influence of a husband's healthcare decision making role on a woman's intention to use contraceptives among Mozambican women. Reprod Health 2015; 12:36. [PMID: 25902830 PMCID: PMC4409755 DOI: 10.1186/s12978-015-0010-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 03/09/2015] [Indexed: 11/10/2022] Open
Abstract
Background Previous studies in developing countries suggest that a husband plays an influential role in a woman’s contraceptive use. The influence of a husband/partner’s healthcare decision making power on a woman’s intention to use contraceptives in Mozambique has not been studied. The present study examined this relationship using data from the 2011 Mozambique Demographic and Health Survey (DHS), which included a nationally representative sample of 7,022 women aged 15-49 years. Methods The primary outcome of interest in the study was a woman’s intention to use contraceptives. The primary exposure of interest was the person making decisions about a woman’s healthcare, dichotomized as the husband/partner alone vs. the woman herself or jointly with her husband/partner. Several potential socio-demographic confounders were adjusted for in overall and stratified multivariable logistic regression models. Adjusted odds ratio (AOR) and the associated 95% confidence interval (CI) are reported. Results The mean age of the sample was 30.4 (95% CI: 30.1 - 30.7) years. Overall, a woman who reported her husband/partner usually made the decision about her healthcare was 19% less likely to report an intention to use contraceptives than a woman who reported that she herself or jointly with her husband/partner made the decision (AOR = 0.81, 95% CI 0.71- 0.92). In stratified analyses, the association remained statistically significant among rural women (AOR = 0.75, 95% CI: 0.65 - 0.87); among women with knowledge of modern contraceptive methods (AOR = 0.83, 95% CI: 0.73 - 0.95); and among women with three or more (AOR = 0.81, 95% CI: 0.68 - 0.97) and two or fewer (AOR = 0.79, 95% CI: 0.65 - 0.96) living children. Conclusions A husband/partner’s healthcare decision making power in the relationship had a significant negative effect on a Mozambican woman’s intention to use contraceptives. These findings have implications for addressing the role of men in the design and implementation of successful family planning programs to improve the contraceptive uptake rate among women in Mozambique.
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Affiliation(s)
- Ramos Mboane
- Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University, 750 Hilltop Drive, 319 Lowry Hall, P. O. Box 5190, Kent, OH, 44242, USA.
| | - Madhav P Bhatta
- Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University, 750 Hilltop Drive, 319 Lowry Hall, P. O. Box 5190, Kent, OH, 44242, USA.
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Tossone K, Jefferis ES, Grey SF, Bilge-Johnson S, Bhatta MP, Seifert P. Poly-traumatization and harmful behaviors in a sample of emergency department Psychiatric Intake Response Center youth. Child Abuse Negl 2015; 40:142-151. [PMID: 25510557 DOI: 10.1016/j.chiabu.2014.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 11/17/2014] [Accepted: 11/21/2014] [Indexed: 06/04/2023]
Abstract
The purpose of this study is to examine risk factors for poly-traumatization, and the impact of poly-traumatization on harmful behaviors (suicidal, self-harm, and violent), among a group of pediatric patients presenting at an emergency department's psychiatric intake response center. We employed a retrospective medical chart review in a children's hospital for a 2-year span (N=260). The study employed 2 statistical analyses. The first analysis used multinomial logistic regression to model the odds of harmful behaviors comparing increasing numbers of co-occurring traumatization types. The second analysis employed latent class modeling techniques in three ways to (a) define different poly-traumatization populations, (b) examine the relationship between predictors and class assignment, and (c) examine the relationship between class assignment and harmful behavioral outcomes. About 62% of the sample presented with at least 1 traumatization type and about 50% one harmful behavior type. Compared to those with 1, 2, or 3 traumatization types, patients with 4 or more traumatization types have higher odds of harmful behaviors. The latent class analysis revealed 2 populations: High serious victimization and minimal traumatization. History of family mental health issues was the only significant predictor of class membership. Class membership was associated with all of the harmful behavioral outcome categories. These findings support consideration of poly-traumatization as a risk factor for the high occurrence of harmful behaviors in this sample of pediatric psychiatric patients and that history of family mental health issues may contribute to the high co-occurrence of poly-traumatization.
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Bhatta MP, Shakya S, Jefferis E. Association of being bullied in school with suicide ideation and planning among rural middle school adolescents. J Sch Health 2014; 84:731-738. [PMID: 25274173 DOI: 10.1111/josh.12205] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 03/11/2014] [Accepted: 04/13/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND This study examined the association of ever being bullied in school with suicide ideation (ever thinking about killing oneself) and ever seriously making a plan to kill oneself (suicide planning) among rural middle school adolescents. METHODS Using the US Centers for Disease Control and Prevention's Middle School Youth Risk Behavior Survey instrument, 2 cross-sectional surveys were conducted among middle school adolescents (N = 1082) in a rural Appalachian county in Ohio in 2009 and 2012. Multivariable logistic regression models assessed the relationship of ever being bullied in school with suicide ideation and planning. RESULTS Overall, a total of 468 participants (43.1%) reported ever being bullied in school, and 22.3% and 13.2% of the adolescents surveyed reported suicide ideation and planning, respectively. In the multivariable analyses, ever being bullied in school was significantly associated with both suicide ideation (odds ratio [OR] = 2.4; 95% confidence interval [CI]: 1.7-3.5) and planning (OR = 2.5; 95% CI: 1.6-3.8). CONCLUSIONS The results show a strong association between being bullied in school and suicide ideation and planning among rural middle school adolescents. Prevention of bullying in school as early as in middle school should be a strategy for reducing suicide ideation and planning among adolescents.
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Affiliation(s)
- Madhav P Bhatta
- College of Public Health, Kent State University, PO Box 5190, Kent, OH 44242.
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Tossone K, Jefferis E, Bhatta MP, Bilge-Johnson S, Seifert P. Risk factors for rehospitalization and inpatient care among pediatric psychiatric intake response center patients. Child Adolesc Psychiatry Ment Health 2014; 8:27. [PMID: 25392713 PMCID: PMC4228274 DOI: 10.1186/1753-2000-8-27] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 09/29/2014] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The study sought to explore the characteristics, risk factors for inpatient recommendation, and risk factors for revisits to a pediatric psychiatric intake response center (PIRC). There are three research questions: 1. What is the general profile of pediatric patients who present at the PIRC? 2. What are the risk factors for patients who repeatedly visit the PIRC? 3. What are the risk factors for PIRC patients who are recommended to inpatient care? METHODS The study utilized a retrospective medical chart review of a random sample (n = 260). A PIRC profile was created using frequency and prevalence calculations, in addition to a survival analysis of patients who return to the PIRC in order to determine how long it takes for PIRC patients to return to the PIRC. Factors that contribute to increased odds of returning to PIRC and being recommended for inpatient treatment were calculated using two logistic regression analyses. RESULTS The average pediatric PIRC patient is about 13 years old, Caucasian, with Medicaid and comes from a divorced or single parent household. About 43% of patients presented at PIRC for suicidal thoughts, ideation, intentions or actions. At least 63% of patients have a history of victimization. The average time to return to PIRC is about 90 days. Patients with a history of victimization, suicidal behavior, learning problems, problems with peers, and a history of violence were at an increased odds of returning to the PIRC. Those patients who were previously admitted to inpatient care and had a family history of mental health issues were at increased odds of being recommended to inpatient treatment. CONCLUSIONS This sample presents with a multitude of issues that contribute to increased odds of revisits to PIRC and inpatient recommendation. These issues seem to come from multiple levels of influence. Future research should expand to similar treatment facilities and use a prospective design to confirm risk factors. Treatment for pediatric psychiatric patients may focus on multiple factors that influence patients' mental health.
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Affiliation(s)
- Krystel Tossone
- Kent State University, Lowry Hall, 750 Hilltop Drive, PO Box 5190, Kent, OH 44242 USA
| | - Eric Jefferis
- Kent State University, Lowry Hall, 750 Hilltop Drive, PO Box 5190, Kent, OH 44242 USA
| | - Madhav P Bhatta
- Kent State University, 319 Lowry Hall, PO Box 5190, Kent, OH 44242 USA
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Bhatta MP, Phillips L. Human Papillomavirus Vaccine Awareness, Uptake, and Parental and Health Care Provider Communication Among 11- to 18-Year-Old Adolescents in a Rural Appalachian Ohio County in the United States. J Rural Health 2014; 31:67-75. [PMID: 25040612 DOI: 10.1111/jrh.12079] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Madhav P. Bhatta
- Department of Biostatistics, Environmental Health Sciences and Epidemiology; College of Public Health, Kent State University; Kent Ohio
| | - Lynette Phillips
- Department of Biostatistics, Environmental Health Sciences and Epidemiology; College of Public Health, Kent State University; Kent Ohio
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Johnson DC, Bhatta MP, Smith JS, Kempf MC, Broker TR, Vermund SH, Chamot E, Aryal S, Lhaki P, Shrestha S. Assessment of high-risk human papillomavirus infections using clinician- and self-collected cervical sampling methods in rural women from far western Nepal. PLoS One 2014; 9:e101255. [PMID: 24978811 PMCID: PMC4076302 DOI: 10.1371/journal.pone.0101255] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 06/04/2014] [Indexed: 12/20/2022] Open
Abstract
Introduction Nepal has one of the highest cervical cancer rates in South Asia. Only a few studies in populations from urban areas have investigated type specific distribution of human papillomavirus (HPV) in Nepali women. Data on high-risk HPV (HR-HPV) types are not currently available for rural populations in Nepal. We aimed to assess the distribution of HR- HPV among rural Nepali women while assessing self-collected and clinician-collected cervico-vaginal specimens as sample collection methods for HPV screening. Methods Study participants were recruited during a health camp conducted by Nepal Fertility Care Center in Achham District of rural far western Nepal. Women of reproductive age completed a socio-demographic and clinical questionnaire, and provided two specimens; one cervical-vaginal specimen using a self-collection method and another cervical specimen collected by health camp auxiliary nurse midwives during a pelvic examination. All samples were tested for 14 different HR-HPV mRNA and also specific for HPV16/18/45 mRNA. Results Of 261 women with both clinician- and self-collected cervical samples, 25 tested positive for HR-HPV, resulting in an overall HR-HPV prevalence of 9.6% (95% confidence Interval [CI]: 6.3–13.8). The overall Kappa value assessing agreement between clinician- and self-collected tests was 0.62 (95% CI: 0.43–0.81), indicating a “good” level of agreement. Abnormal cytology was reported for 8 women. One woman identified with squamous cell carcinoma (SCC), and 7 women with high grade squamous intraepithelial lesions (HSIL). Seven of the 8 women tested positive for HR-HPV (87.5%) in clinician-collected samples and 6 in self-collected samples (75.0%). Conclusion This is the first study to assess HR-HPV among rural Nepali women. Self-collected sampling methods should be the subject of additional research in Nepal for screening HR-HPV, associated with pre-cancer lesions and cancer, in women in rural areas with limited access to health services.
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Affiliation(s)
- Derek C. Johnson
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Madhav P. Bhatta
- College of Public Health, Kent State University, Kent, Ohio, United States of America
| | - Jennifer S. Smith
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Mirjam-Colette Kempf
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Thomas R. Broker
- Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Sten H. Vermund
- Vanderbilt University, Institute for Global Health, Nashville, Tennessee, United States of America
| | - Eric Chamot
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Shilu Aryal
- Nepal Family Health Division, Kathmandu, Nepal
| | - Pema Lhaki
- Nepal Fertility Care Center, Kathmandu, Nepal
| | - Sadeep Shrestha
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- * E-mail:
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Bhatta MP, Jefferis E, Kavadas A, Alemagno SA, Shaffer-King P. Suicidal behaviors among adolescents in juvenile detention: role of adverse life experiences. PLoS One 2014; 9:e89408. [PMID: 24586756 PMCID: PMC3933541 DOI: 10.1371/journal.pone.0089408] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 01/20/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The purpose of this study was to assess the influence of multiple adverse life experiences (sexual abuse, homelessness, running away, and substance abuse in the family) on suicide ideation and suicide attempt among adolescents at an urban juvenile detention facility in the United States. MATERIALS AND METHODS The study sample included a total of 3,156 adolescents processed at a juvenile detention facility in an urban area in Ohio between 2003 and 2007. The participants, interacting anonymously with a voice enabled computer, self-administered a questionnaire with 100 items related to health risk behaviors. RESULTS Overall 19.0% reported ever having thought about suicide (suicide ideation) and 11.9% reported ever having attempted suicide (suicide attempt). In the multivariable logistic regression analysis those reporting sexual abuse (Odds Ratio = 2.75; 95% confidence interval = 2.08-3.63) and homelessness (1.51; 1.17-1.94) were associated with increased odds of suicide ideation, while sexual abuse (3.01; 2.22-4.08), homelessness (1.49; 1.12-1.98), and running away from home (1.38; 1.06-1.81) were associated with increased odds of a suicide attempt. Those experiencing all four adverse events were 7.81 times more likely (2.41-25.37) to report having ever attempted suicide than those who experienced none of the adverse events. CONCLUSIONS Considering the high prevalence of adverse life experiences and their association with suicidal behaviors in detained adolescents, these factors should not only be included in the suicide screening tools at the intake and during detention, but should also be used for the intervention programming for suicide prevention.
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Affiliation(s)
- Madhav P. Bhatta
- Department of Biostatistics, Environmental Health Sciences and Epidemiology, College of Public Health, Kent State University, Kent, Ohio, United States of America
| | - Eric Jefferis
- Department of Social and Behavioral Sciences, College of Public Health, Kent State University, Kent, Ohio, United States of America
| | - Angela Kavadas
- Department of Social and Behavioral Sciences, College of Public Health, Kent State University, Kent, Ohio, United States of America
| | - Sonia A. Alemagno
- Department of Health Policy and Management, College of Public Health, Kent State University, Kent, Ohio, United States of America
| | - Peggy Shaffer-King
- Department of Social and Behavioral Sciences, College of Public Health, Kent State University, Kent, Ohio, United States of America
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Scarlett HP, Nisbett RA, Stoler J, Bain BC, Bhatta MP, Castle T, Harbertson J, Brodine SK, Vermund SH. South-to-North, cross-disciplinary training in global health practice: ten years of lessons learned from an infectious disease field course in Jamaica. Am J Trop Med Hyg 2011; 85:397-404. [PMID: 21896794 PMCID: PMC3163856 DOI: 10.4269/ajtmh.2011.10-0524] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 05/17/2011] [Indexed: 01/02/2023] Open
Abstract
Global commerce, travel, and emerging and resurging infectious diseases have increased awareness of global health threats and opportunities for collaborative and service learning. We review course materials, knowledge archives, data management archives, and student evaluations for the first 10 years of an intensive summer field course in infectious disease epidemiology and surveillance offered in Jamaica. We have trained 300 students from 28 countries through collaboration between the University of the West Indies and U.S. partner universities. Participants were primarily graduate students in public health, but also included health professionals with terminal degrees, and public health nurses and inspectors. Strong institutional synergies, committed faculty, an emphasis on scientific and cultural competencies, and use of team-based field research projects culminate in a unique training environment that provides participants with career-developing experiences. We share lessons learned over the past decade, and conclude that South-to-North leadership is critical in shaping transdisciplinary, cross-cultural, global health practice.
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Affiliation(s)
- Henroy P Scarlett
- Department of Community Health and Psychiatry, and Office of the Vice Chancellor, University of the West Indies, Mona, Kingston, Jamaica.
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Bhatta MP, Vermund SH, Hoesley CJ. Human immunodeficiency virus infection in Alabama women: sociodemographic, behavioral, and reproductive health characteristics and factors associated with lack of human immunodeficiency virus-1 viral control. Am J Med Sci 2010; 339:133-140. [PMID: 20087169 DOI: 10.1097/maj.0b013e3181c300f9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) infection among women in the southern United States is on the rise. This study examined sociodemographic profile and behavioral risk factors for HIV and sexually transmitted infections and assessed factors associated with HIV-1 viral control in a cohort of 280 HIV-infected Alabama women aged 17 to 66 years. METHODS Women receiving care for HIV infection at a university outpatient HIV clinic were enrolled in the study. Women completed a self-administered questionnaire on demographics and behavioral risk factors at enrollment. They were followed up with appointments at least every 6 months with Papanicolaou smears, cervicovaginal lavages, cervical and vaginal swabs, and blood specimens collected at each visit. RESULTS Of the women in the study, 69% were black, had mean age of 36 years, and approximately three fourths were mothers with annual household income <$20,000. White women were likely to have been HIV infected for a longer period (50.2 versus 36.3 months; P = 0.02) and had significantly lower viral loads at enrollment (P = 0.04) than black women. Factors associated with lack of HIV-1 control (> or =10,000 RNA copies/mL) at enrollment included black race/ethnicity (odds ratio [OR]: 2.8; 95% confidence interval [CI]: 1.2-6.8), CD4+ T-cell count <200 cells/microL (OR: 20.1; CI: 8.6-47.0), being diagnosed with HIV <6 months (OR: 3.5; CI: 1.4-8.9) and not being on any antiretroviral therapy (OR: 2.5; CI: 1.1-5.7). CONCLUSION Poorer HIV-1 viral control in black women at enrollment may indicate suboptimal access to HIV testing, delays in receipt of medical care after HIV-1 diagnosis, and/or some underlying biologic or social race-related influence.
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Affiliation(s)
- Madhav P Bhatta
- Department of Biostatistics, Epidemiology and Environmental Health Science, Kent State University, OH 44242, USA.
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Vermund SH, Bhatta MP, Sahasrabuddhe VV. Papillomavirus infections. Infect Dis (Lond) 2010. [DOI: 10.1016/b978-0-323-04579-7.00059-9] [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: 10/23/2022] Open
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Alangaden GJ, Aldape MJ, Allardet-Servent J, Allen UD, Ammerlaan HS, Angelakis E, Artenstein A, Asboe D, Asiedu KB, Atherton JC, Aw TC, Baid-Agrawal S, Bailey R, Bandel C, Barie PS, Barillo DJ, Bart PA, Bayston R, Beard CB, Beeching NJ, Bégué RE, Benhamou Y, Benson CA, Berbari EF, Berendt AR, Bhatta MP, Bille J, Bitnun A, Black FT, Blair I, Blanche S, Bleck TP, Bleeker-Rovers CP, Bleijenberg G, Bloch KC, Bonten MJ, Boucher CA, Bourayou R, Bouza ES, Bowie WR, Brause BD, Brisse S, Britton W, Brook I, Brown DW, Brun-Buisson C, Brust JC, Bryant AE, Bryskier A, Buller RML, Bush K, Calandra T, Cameron DW, Caraël M, Carr MJ, Casas I, Chambers ST, Chiller KG, Chiller TM, Chiodini PL, Chopra I, Chu AC, Chung KK, Clark BM, Clumeck N, Cockerell CJ, Cohen J, Collinge J, Conlon CP, Corey GR, Cross A, Cross JH, Currier J, Curtis CM, Dallabetta G, Davidson RN, Davies J, Day J, Day NP, De Gascun CF, de Wit S, Delmont J, Dennis DT, Diemert DJ, Doganay M, Doherty T, Dolecek C, Donati SY, Dondorp AM, Doudier B, Drancourt M, Drekonja DM, Drew RH, Duker JS, Dummer JS, Edwards CN, Ekkelenkamp MB, Enright MC, Epstein PR, Erard V, Eziefula AC, Feinberg MB, Fenollar F, Fenwick A, Fernandez L, Fierer J, Finch RG, Flexner CW, Fluit AC, Ford-Jones EL, Fournier PE, Fraser V, French MA, Friedland JS, Fritz JM, Furuya EY, Gage KL, Garcia LS, Gastañaduy AS, Ghanem KG, Giannella M, Glaser CA, Glesby MJ, Glover S, Glupczynski Y, Gnann JW, Goddard AF, Goldstein EJ, González IJ, Gorbach SL, Gottstein B, Gowda R, Grabenstein JD, Grange JM, Green MD, Green ST, Greenblatt DT, Greenwood B, Gregson AL, Groll AH, Gupta AK, Gwee KA, Hall W, Hammer SM, Handa S, Hanfelt-Goade D, Harari A, Harris M, Hartman BJ, Hay RJ, Henderson DK, Hensley LE, Herbert L, Hill DR, Hills TJ, Hinze JD, Hirsch HH, Hirschel B, Hoepelman AI, Holland SM, Horgan MM, Howe R, Hughes JM, Hull MW, Inderlied CB, Ison MG, Jenks PJ, Johnson JR, Jones T, Kanno M, Kauffman C, Kelly P, Kendler JS, Keynan Y, Khan AS, Kho GT, Kinghorn GR, Klapper PE, Kluytmans JAJW, Kok M, Koné-Paut I, Krieger JN, Kroes AC, Kroon FP, Kubin CJ, La Rosa AM, Lalani T, Lalloo DG, Lambert H, Landraud L, Lawn SD, Pharm PL, Leone M, Levi I, Levitt AM, Lindquist HDA, Lloyd G, Looney DJ, Lowy FD, Luft BJ, Lynn WA, Macielag MJ, Mackowiak PA, MacPherson PA, Maghraoui-Slim V, Main J, Mallet V, Mangino JE, Manuel O, Marchetti O, Marks K, Marr KA, Martin C, Martín-Rabadán P, Martinez AJ, Mascini EM, Mayer KH, McCormick JB, McGready R, McKendrick MW, Mead S, Mégraud F, Meheus AZ, Meintjes G, Michaels MG, Miles M, Miller A, Mimiaga MJ, Mingeot-Leclercq MP, Mitchell TG, Moise PA, Montaner J, Moore CB, Moreillon P, Morgan-Capner P, Montessori V, Moss P, Muñoz P, Naber KG, Nakhla S, Narain JP, Nathwani D, Newton P, Nguyen C, Nicolle LE, Niederman MS, Noel GJ, Norrby SR, Nosten F, Notarangelo LD, Nyirjesy P, O'Connell PR, Odorico JS, Ong EL, Opal SM, Ormerod LP, Osmon DR, Ottesen EA, Palacios G, Pantaleo G, Papazian L, Parola P, Pascual MA, Patrozou E, Paya C, Peacock SJ, Pechère JC, Perkins MD, Peters B, Pfyffer GE, Pham PA, Piot P, Placko-Parola G, Pol S, Posfay-Barbe KM, Powderly WG, Pozniak A, Prod'hom G, Quinn TC, Rahn DW, Rana AI, Raoult D, Raz R, Razonable R, Read RC, Reynolds SJ, Richardson MD, Robinson CC, Rooijakkers SH, Rosenbluth D, Rosenzweig SD, Rovery C, Rubin RH, Rubinovitch B, Rubins KH, Rubinstein E, Ryan G, Ryder S, Safren S, Sahasrabuddhe VV, Saikku PA, Sakoulas G, Salazar JC, Salvaggio MR, Schaffer K, Schmitz FJ, Schooley RT, Schumacher RF, Scrimgeour EM, Seddon J, Seifert H, Serjeant GR, Sha BE, Shah KV, Shapiro DS, Sheehan G, Shoham S, Simmons CP, Simonsen KA, Singh N, Slack MP, Sobel JD, Sopirala MM, Spacek LA, Sriskandan S, Stanley SL, Steckelberg JM, Stephenson I, Stevens DL, Straus WL, Sturm W, Summerbell RC, Susa JS, Tabrizi SJ, Tack MA, Taplitz R, Tebas P, Temmerman M, Thijsen SF, Thomas LD, Thomson G, Thwaites GE, Tirelli U, Tolkoff-Rubin NE, Tønjum T, Torriani FJ, Townsend GC, Masó GT, Tulkens PM, Tunkel AR, Vaccher E, Vallet-Pichard A, Van Bambeke F, van de Beek D, van der Meer JW, van Loon AM, van Putten J, Vaudaux BP, Vermund SH, Verstraelen H, Verweij P, Viscidi RP, Visvanathan K, Visvesvara GS, von Seidlein L, Wagenlehner FM, Wahl-Jensen V, Walsh TJ, Warhurst DC, Warnock DW, Warrell DA, Warrell MJ, Warris A, Weber R, Weidner W, Weston VC, Whimbey E, Whitby M, White PJ, Whitty CJ, Willems RJ, Williams E, Wilson C, Wilson ME, Winn RE, Winthrop KL, Wiselka MJ, Wisplinghoff H, Wolfe CR, Wood R, Wright N, Yankaskas JR, Zaidi NA, Zenilman JM, Zhang Y, Zuckerman AJ, Zuckerman JN, Zumla A. Contributors. Infect Dis (Lond) 2010. [DOI: 10.1016/b978-0-323-04579-7.00347-6] [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: 11/28/2022] Open
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Bhatta MP, Stringer JSA, Phanuphak P, Vermund SH. Mother-to-child HIV transmission prevention in Thailand: physician zidovudine use and willingness to provide care. Int J STD AIDS 2003; 14:404-10. [PMID: 12816669 DOI: 10.1258/095646203765371303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We conducted a mail survey of Thai physicians involved in obstetric care to assess attitudes and practices regarding zidovudine use during pregnancy and willingness to provide care for HIV-infected women in 1999. Of 845 respondents, 57% reported using perinatal zidovudine prophylaxis, an increase from 20% reported in 1997. Highest failure-to-use rates (52%) were among the respondents from Central and Southern Thailand and lowest failure rate was among those from the North (37%). Predictors of failure to use zidovudine in a multivariable logistic regression analysis were not knowing a source from which to obtain zidovudine (odds ratio [OR]=3.1), working in smaller hospitals (district/provincial/private hospitals) (OR=2.0), being from Eastern/Central/Southern Thailand (OR=1.4), unwillingness to perform caesarean section delivery on a HIV-positive women (OR=1.8), having provided antenatal care to fewer than 100 women in 1998 (OR=1.7), and unfamiliarity with Pediatric AIDS Clinical Trial Group 076 protocol (OR=2.9). A number of respondents described themselves as unwilling to perform pelvic examinations (15%), vaginal delivery (29%), or caesarean sections (37%) on HIV-infected pregnant women. About 39% of the respondents advocated elective terminations of pregnancy for HIV-infected women. Our survey indicates an increasing willingness of Thai physicians to use antiretroviral therapy to prevent mother-to-child HIV transmission and to provide obstetric care to HIV-infected women. However, availability and affordability remained major barriers to more widespread antiretroviral use in 1999.
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Affiliation(s)
- M P Bhatta
- Department of Epidemiology and International Health, University of Alabama at Birmingham, BBRB 206, 845 19th Street South, Birmingham, Alabama 35294-2170, USA
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Nichols SA, Bhatta MP, Lewis J, Vermund SH. Prenatal HIV counseling, testing, and antiretroviral prophylaxis by obstetric and family medicine providers in Alabama. Am J Med Sci 2002; 324:305-9. [PMID: 12495296 DOI: 10.1097/00000441-200212000-00003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The study reported here assessed the implementation of recommendations for routine universal prenatal counseling and voluntary HIV testing among Alabama physicians who provide prenatal care and determined factors associated with noncompliance. METHODS Voluntary, confidential mailed survey of obstetrics and family medicine practitioners. RESULTS Of the 138 physicians who responded to a mailed survey in Alabama, 17 (12.3%) indicated that they did not offer universal HIV counseling and testing to pregnant women. Factors associated with failure to offer universal HIV counseling and testing included having more than 50% of patients refuse HIV counseling and testing when offered and never knowingly having given prenatal/perinatal care to women with HIV. Low/medium familiarity with the US Public Health Service recommendations for perinatal zidovudine use to reduce HIV transmission and physician specialty are also suggested as predictors of not offering universal testing. CONCLUSIONS Despite the well-established benefits of antiretroviral prophylaxis to prevent vertical transmission of HIV, some physicians in Alabama have been slow to adopt universal testing of their pregnant patients for HIV in the prenatal period. Practitioner education is as important as patient education in eliminating pediatric HIV in the Deep South.
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Affiliation(s)
- Stacy A Nichols
- Department of Epidemiology & International Health, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama 35294-2170, USA
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