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Ajayi T, Pawelek J, Bhargava H, Faksh A, Radin J. Self-Reported Medication Use Across Racial and Rural or Urban Subgroups of People Who Are Pregnant in the United States: Decentralized App-Based Cohort Study. JMIR Form Res 2023; 7:e50867. [PMID: 38015604 DOI: 10.2196/50867] [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: 07/17/2023] [Revised: 10/04/2023] [Accepted: 10/20/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Maternal health outcomes have been underresearched due to people who are pregnant being underrepresented or excluded from studies based on their status as a vulnerable study population. Based on the available evidence, Black people who are pregnant have dramatically higher maternal morbidity and mortality rates compared to other racial and ethnic groups. However, insights into prenatal care-including the use of medications, immunizations, and prenatal vitamins-are not well understood for pregnant populations, particularly those that are underrepresented in biomedical research. Medication use has been particularly understudied in people who are pregnant; even though it has been shown that up to 95% of people who are pregnant take at least 1 or more medications. Understanding gaps in use could help identify ways to reduce maternal disparities and optimize maternal health outcomes. OBJECTIVE We aimed to characterize and compare the use of prenatal vitamins, immunizations, and commonly used over-the-counter and prescription medications among people who are pregnant, those self-identifying as Black versus non-Black, and those living in rural versus urban regions in the United States. METHODS We conducted a prospective, decentralized study of 4130 pregnant study participants who answered survey questionnaires using a mobile research app that was only available on iOS (Apple Inc) devices. All people who were pregnant, living in the United States, and comfortable with reading and writing in English were eligible. The study was conducted in a decentralized fashion with the use of a research app to facilitate enrollment using an eConsent and self-reported data collection. RESULTS Within the study population, the use of prenatal vitamins, antiemetics, antidepressants, and pain medication varied significantly among different subpopulations underrepresented in biomedical research. Black participants reported significantly lower frequencies of prenatal vitamin use compared to non-Black participants (P<.001). The frequency of participants who were currently receiving treatment for anxiety and depression was also lower among Black and rural groups compared to their non-Black and urban counterparts, respectively. There was significantly lower use of antidepressants (P=.002) and antiemetics (P=.02) among Black compared to non-Black participants. While prenatal vitamin use was lower among participants in rural areas, the difference between rural and urban groups did not reach statistical significance (P=.08). There were no significant differences in vaccine uptake for influenza or tetanus-diphtheria-pertussis (TDaP) across race, ethnicity, rural, or urban status. CONCLUSIONS A prospective, decentralized app-based study demonstrated significantly lower use of prenatal vitamins, antiemetics, and antidepressants among Black pregnant participants. Additionally, significantly fewer Black and rural participants reported receiving treatment for anxiety and depression during pregnancy. Future research dedicated to identifying the root mechanisms of these differences can help improve maternal health outcomes, specifically for diverse communities.
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Affiliation(s)
- Toluwalase Ajayi
- Scripps Research Translational Institute, Scripps Research, La Jolla, CA, United States
- Faculty of Pediatrics and Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Jeff Pawelek
- Scripps Research Translational Institute, Scripps Research, La Jolla, CA, United States
| | | | - Arij Faksh
- Scripps Health, La Jolla, CA, United States
| | - Jennifer Radin
- Scripps Research Translational Institute, Scripps Research, La Jolla, CA, United States
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Moyer KM, Verbeck N, Barnett MD, Denney-Koelsch EM, Ajayi T, Humphrey LM, Malhotra S, Ragsdale L, Waldman ED, Gustin JL. A National Survey to Guide Pediatric Curricula for Hospice and Palliative Medicine Fellows. J Pain Symptom Manage 2022; 64:e165-e171. [PMID: 35523388 DOI: 10.1016/j.jpainsymman.2022.04.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/08/2022] [Accepted: 04/19/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Kristen M Moyer
- Hospice and Community Care (K.M.M.), Lancaster, Pennsylvania, USA.
| | - Nicole Verbeck
- The Ohio State University College of Medicine (N.V.), Columbus, Ohio, USA
| | - Michael D Barnett
- University of Alabama at Birmingham (M.D.B.), Birmingham, Alabama, USA
| | | | - Toluwalase Ajayi
- Scripps Health and Rady Children's Hospital (T.A.), San Diego, California, USA
| | - Lisa M Humphrey
- Nationwide Children's Hospital (L.M.H.), Columbus, Ohio, USA
| | - Sonia Malhotra
- Tulane University School of Medicine and Louisiana State University School of Medicine (S.M.), New Orleans, Los Angeles, USA
| | - Lindsay Ragsdale
- University of Kentucky College of Medicine (L.R.), Lexington, Kentucky, USA
| | - Elisha D Waldman
- Northwestern University School of Medicine / Ann & Robert H. Lurie Children's Hospital of Chicago (E.D.W.), Chicago, Illinois, USA
| | - Jillian L Gustin
- The Ohio State University Wexner Medical Center (J.L.G.), Columbus, Ohio, USA
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Linebarger JS, Johnson V, Boss RD, Linebarger JS, Collura CA, Humphrey LM, Miller EG, Williams CSP, Rholl E, Ajayi T, Lord B, McCarty CL. Guidance for Pediatric End-of-Life Care. Pediatrics 2022; 149:186860. [PMID: 35490287 DOI: 10.1542/peds.2022-057011] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The final hours, days, and weeks in the life of a child or adolescent with serious illness are stressful for families, pediatricians, and other pediatric caregivers. This clinical report reviews essential elements of pediatric care for these patients and their families, establishing end-of-life care goals, anticipatory counseling about the dying process (expected signs or symptoms, code status, desired location of death), and engagement with palliative and hospice resources. This report also outlines postmortem tasks for the pediatric team, including staff debriefing and bereavement.
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Affiliation(s)
- Jennifer S Linebarger
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri, Kansas City, School of Medicine, Kansas City, Missouri
| | - Victoria Johnson
- Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Renee D Boss
- Department of Pediatrics, Johns Hopkins University School of Medicine, Berman Institute of Bioethics, Baltimore, Maryland
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Ng S, Ajayi T, Schaefer A, Pollard C, Bahig H, Garden A, Rosenthal D, Gunn G, Phan J, Morrison W, Johnson J, Mohamed A, Sturgis E, Fuller C. Surveillance Imaging for Patients with Head and Neck Cancer Treated with Definitive Radiotherapy: A Partially Observed Markov Decision Process Model. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.234] [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: 11/28/2022]
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Ajayi T, Dara R, Misener M, Pasma T, Moser L, Poljak Z. Herd-level prevalence and incidence of porcine epidemic diarrhoea virus (PEDV) and porcine deltacoronavirus (PDCoV) in swine herds in Ontario, Canada. Transbound Emerg Dis 2018; 65:1197-1207. [PMID: 29607611 PMCID: PMC7169835 DOI: 10.1111/tbed.12858] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Indexed: 11/30/2022]
Abstract
Porcine epidemic diarrhoea virus (PEDV) and porcine deltacoronavirus (PDCoV) were first identified in Canada in 2014. Surveillance efforts have been instrumental in controlling both diseases. In this study, we provide an overview of surveillance components for the two diseases in Ontario (Canada), as well as PEDV and PDCoV incidence and prevalence measures. Swine herds located in the Province of Ontario, of any type, whose owners agreed to participate in a voluntary industry‐led disease control programme (DCP) and with associated diagnostic or epidemiological information about the two swine coronaviruses, were eligible to be included for calculation of disease frequency at the provincial level. PEDV and PDCoV data stored in the industry DCP database were imported into the R statistical software and analysed to produce weekly frequency of incidence counts and prevalence counts, in addition to yearly herd‐level incidence risk and prevalence between 2014 and 2016. The yearly herd‐level incidence risk of PEDV, based on industry data, was 13.5%, 3.0% and 1.4% (95% CI: 11.1–16.2, 2.0–4.2, 0.8–2.3), while the yearly herd‐level incidence risk of PDCoV was 1.1%, 0.3%, and 0.1% (95% CI: 0.5–2.2, 0.1–0.9, 0.0–0.5), for 2014, 2015 and 2016, respectively. Herd‐level prevalence estimates for PEDV in the last week of 2014, 2015 and 2016 were 4.4%, 2.3% and 1.4%, respectively (95% CI: 3.1–6.0, 1.5–3.3, 0.8–2.2), while herd‐level prevalence estimates for PDCoV in the last week of 2014, 2015 and 2016 were 0.5%, 0.2% and 0.2%, respectively (95% CI: 0.1–1.2, 0.0–0.6, 0.0–0.6). Collectively, our results point to low and decreasing incidence risk and prevalence for PEDV and PDCoV in Ontario, making both diseases possible candidates for disease elimination at the provincial level.
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Affiliation(s)
- T Ajayi
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - R Dara
- School of Computer Science, University of Guelph, Guelph, ON, Canada
| | - M Misener
- Ontario Swine Health Advisory Board (OSHAB), Stratford, ON, Canada
| | - T Pasma
- Ontario Ministry of Agriculture, Food and Rural Affairs (OMAFRA), Guelph, ON, Canada
| | - L Moser
- Swine Health Ontario, Guelph, ON, Canada
| | - Z Poljak
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
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Affiliation(s)
- Steven R Steinhubl
- Scripps Translational Science Institute, La Jolla, California, CA 92037, USA; Wave Research Center, La Jolla, California, USA.
| | - Kwang-Il Kim
- Scripps Translational Science Institute, La Jolla, California, CA 92037, USA; Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Toluwalase Ajayi
- Scripps Translational Science Institute, La Jolla, California, CA 92037, USA
| | - Eric J Topol
- Scripps Translational Science Institute, La Jolla, California, CA 92037, USA; Wave Research Center, La Jolla, California, USA
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Ajayi T, Babatunde O, Jaiyeola O, Omughelli K, Lapite T, Nwankwo N, Olubeko A, Vaughan T, Olufolabi A. Hands-On educational model in Nigeria increases interest in STEM
careers. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.033] [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: 10/21/2022] Open
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Rajbhandari R, Barton K, Juncadella AC, Rubin AK, Ajayi T, Wu Y, Ananthakrishnan AN, Chung RT. Discontinuity of care for mothers with chronic hepatitis B diagnosed during pregnancy. J Viral Hepat 2016; 23:561-8. [PMID: 26940754 DOI: 10.1111/jvh.12524] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 02/02/2016] [Indexed: 01/05/2023]
Abstract
Assiduous measures are taken to prevent perinatal transmission of hepatitis B virus (HBV) to infants; it is unclear whether the mothers receive appropriate care for their chronic HBV. We sought to assess the quality of HBV care in hepatitis B surface antigen (HBsAg)-positive mothers following pregnancy. HBsAg-positive women (n = 243) who had sought prenatal care at Massachusetts General Hospital were retrospectively identified and charts reviewed. The primary outcome was adherence to the American Association for the Study of Liver Diseases (AASLD) and American College of Obstetricians and Gynecologists guidelines. Over one-third (37%) of women were first diagnosed with HBV infection at a prenatal visit. One-third (32%) did not undergo timely liver function test measurements. HBV DNA was never measured in 26% and was untimely in 34% of patients. One-third (34%) of the women were at high-risk for HCC based on AASLD criteria, yet only 33% of these women underwent timely imaging. Nearly half (49%) never saw a liver specialist for their HBV care. In multivariate analysis, women were 3.7 times more likely to have a timely ALT and 8.1 times more likely to have a timely HBV DNA if they were followed by a liver specialist (P = 0.001, <0.001). We demonstrate remarkably inadequate and discontinuous HBV care for chronically infected mothers following pregnancy. As HBV infection is already being identified prenatally, quality improvement measures encompassing obstetricians, primary care providers and hepatologists are needed to ensure that HBV-infected women are linked to care postpregnancy.
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Affiliation(s)
- R Rajbhandari
- Gastroenterology Division, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - K Barton
- Bureau of Infectious Disease, Massachusetts Department of Public Health, Hinton State Laboratory Institute, Jamaica Plain, MA, USA
| | - A C Juncadella
- Harvard Medical School, Boston, MA, USA.,Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - A K Rubin
- Harvard Medical School, Boston, MA, USA.,Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - T Ajayi
- Department of Medicine, Salem Hospital, Salem, MA, USA
| | - Y Wu
- Gastroenterology Division, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - A N Ananthakrishnan
- Gastroenterology Division, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - R T Chung
- Gastroenterology Division, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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Kerem E, Wilschanski M, Sermet-Gaudelus I, De Boeck K, Accurso F, Konstan M, Rowe S, Elfring G, Spiegel R, Peltz S, Barth J, Ajayi T. 94 The effect of Pseudomonas aeruginosa infection on pulmonary function outcome in a cohort of patients with nonsense mutation cystic fibrosis. J Cyst Fibros 2014. [DOI: 10.1016/s1569-1993(14)60230-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ajayi T, Konstan M, Accurso F, De Boeck K, Kerem E, Rowe S, Sermet-Gaudelus I, Wilschanski M, Brody A, Miller N, Elfring G, Spiegel R, Peltz S, Barth J. 63 The use of high resolution computerized tomography of the chest in evaluating the effect of ataluren in nonsense mutation cystic fibrosis (nmCF) lung disease. J Cyst Fibros 2013. [DOI: 10.1016/s1569-1993(13)60205-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kerem E, Wilschanski M, Sermet-Gaudelus I, De Boeck K, Accurso F, Konstan M, Rowe S, Miller N, Elfring G, Spiegel R, Peltz S, Barth J, Ajayi T. WS7.5 Interim results of the phase 3 open-label study of ataluren in nonsense mutation cystic fibrosis (nmCF). J Cyst Fibros 2013. [DOI: 10.1016/s1569-1993(13)60044-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Nathaniel-Wurie L, Martin G, Cooper G, Bernier GLD, Ajayi T, Martineau F, Cridford B, Lako S. PS33 Health-Seeking Behaviour in the Era of Free Healthcare in Urban Slums in Sierra Leone. J Epidemiol Community Health 2012. [DOI: 10.1136/jech-2012-201753.132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Yahaya T, Okpuzor J, Ajayi T. The Prophylactic Efficacy of Roselle [H. sabdariffa], Moringa [Moringa oleifera], Ginger [Z. officinale] and Ugwu [T. occidentalis] on the Hematology and Serum Protein of Albino Rats [Rattus norvegicus] Exposed to Cement Dust. Research J of Medicinal Plant 2012. [DOI: 10.3923/rjmp.2012.189.196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Wilschanski M, Miller LL, Shoseyov D, Blau H, Rivlin J, Aviram M, Cohen M, Armoni S, Yaakov Y, Pugatsch T, Pugatch T, Cohen-Cymberknoh M, Miller NL, Reha A, Northcutt VJ, Hirawat S, Donnelly K, Elfring GL, Ajayi T, Kerem E. Chronic ataluren (PTC124) treatment of nonsense mutation cystic fibrosis. Eur Respir J 2011; 38:59-69. [PMID: 21233271 DOI: 10.1183/09031936.00120910] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In a subset of patients with cystic fibrosis (CF), nonsense mutations (premature stop codons) disrupt production of full-length, functional CF transmembrane conductance regulator (CFTR). Ataluren (PTC124) allows ribosomal readthrough of premature stop codons in mRNA. We evaluated drug activity and safety in patients with nonsense mutation CF who took ataluren three times daily (morning, midday and evening) for 12 weeks at either a lower dose (4, 4 and 8 mg·kg(-1)) or higher dose (10, 10 and 20 mg·kg(-1)). The study enrolled 19 patients (10 males and nine females aged 19-57 yrs; dose: lower 12, higher seven) with a classic CF phenotype, at least one CFTR nonsense mutation allele, and an abnormal nasal total chloride transport. Both ataluren doses were similarly active, improving total chloride transport with a combined mean change of -5.4 mV (p<0.001), and on-treatment responses (at least -5 mV improvement) and hyperpolarisations (values more electrically negative than -5 mV) in 61% (p<0.001) and 56% (p = 0.002) of patients. CFTR function was greater with time and was accompanied by trends toward improvements in pulmonary function and CF-related coughing. Adverse clinical and laboratory findings were uncommon and usually mild. Chronic ataluren administration produced time-dependent improvements in CFTR activity and clinical parameters with generally good tolerability.
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Affiliation(s)
- M Wilschanski
- Paediatric Gastroenterology, Hadassah University Hospital, Mount Scopus POB 24035, Jerusalem, 91240, Israel.
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