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Giloyan A, Khachadourian V, Hakobyan V, Kirakosyan L, Petrosyan V, Harutyunyan T. Migraine headache and other risk factors associated with glaucoma among the adult population living in Armenia: a case-control study. Int Ophthalmol 2024; 44:188. [PMID: 38647698 DOI: 10.1007/s10792-024-03145-2] [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: 04/21/2023] [Accepted: 04/11/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE This study aimed to assess the association between migraine headache and glaucoma among the adult population living in Armenia. METHODS This case-control study recruited 145 cases with glaucoma and 250 controls without glaucoma and other ocular disorders except refractive error from Optomed Canada Diagnostic Eye Center in Armenia. A structured questionnaire contained questions on socio-demographics, family history of glaucoma and stroke, ocular health, smoking, migraine, and obstructive sleep apnea. The Migraine Screening Questionnaire assessed possible migraine and the Berlin Questionnaire measured obstructive sleep apnea. RESULTS The mean ages of cases and controls were 63.3 (SD = 12.3) and 39.5 (SD = 13.5), respectively. Females comprised 62.8% of cases and 69.1% of controls. A total of 17.8% of cases and 19.0% of controls had possible migraine. In the adjusted analysis older age (OR 1.17; 95% CI 1.12; 1.23), average/lower than average socio-economic status (OR 5.27; 95% CI 1.30; 21.3), and family history of glaucoma (OR 4.25; 95% CI 1.51; 11.9) were associated with high-tension glaucoma. CONCLUSION Timely case detection of glaucoma among those with average/low socio-economic status and those with family history of glaucoma could prevent further progression of the disease. Further studies to explore the relationship between migraine headache and specific types of glaucoma may be worthwhile.
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Affiliation(s)
- Aida Giloyan
- American University of Armenia, Yerevan, Armenia.
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Harutyunyan T, Sargsyan Z, Sahakyan S, Chiloyan A, Melkom Melkomian D, Khachadourian V. Predicting COVID-19 vaccination uptake in Armenia using the Health Belief Model: Results from a nationwide survey. Hum Vaccin Immunother 2023; 19:2165383. [PMID: 36688424 PMCID: PMC9980550 DOI: 10.1080/21645515.2023.2165383] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Health behavior theories have been effectively used for studying populations' awareness, attitudes, and beliefs related to COVID-19 preventative behaviors. The aim of this study was to explore the factors associated with the intention to get vaccinated against COVID-19 in the Armenian population using the Health Belief Model (HBM) as a framework. We applied stratified two-stage random sampling to conduct a telephone survey of 3,483 adults in 2021. The multi-domain survey instrument included questions on socio-demographic characteristics, COVID-19-related knowledge, COVID-19 susceptibility, severity and self-efficacy beliefs, sources of information on COVID-19, COVID-19 vaccination practice, and its benefits and barriers. We performed bivariate and hierarchical multivariate regression analysis with the entry of variables in blocks. In total, about 12% of the sample (n = 393) was vaccinated against COVID-19. Of 2,838 unvaccinated participants, about 53% (n = 1516) had an intention to get vaccinated. The final hierarchical logistic regression model containing socio-demographic characteristics, knowledge about COVID-19, and HBM constructs explained 43% of the variance in the intention to get vaccinated against COVID-19. Participants' age, employment status, average monthly expenditures, perceived threat, benefits, perceived barriers, self-efficacy, and cues to action were significant and independent predictors of the intention to get COVID-19 vaccination. This study confirmed the utility of the HBM in highlighting drivers of an important health-protective behavior in the context of pandemics. Health policy makers, communication specialists, and healthcare providers should particularly stress the effectiveness and safety of the vaccines in their efforts to increase vaccination rates and focus on unemployed and low-income population groups.
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Affiliation(s)
- Tsovinar Harutyunyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Zhanna Sargsyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Serine Sahakyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Araz Chiloyan
- Public Health Department, Ministry of Health, Yerevan, Armenia
| | | | - Vahe Khachadourian
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
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Modasi J, Khachadourian V, O'Hora K, Kushan L, Slavich GM, Shields GS, Velthorst E, Bearden CE. Associations between acute and chronic lifetime stressors and psychosis-risk symptoms in individuals with 22q11.2 copy number variants. Psychol Med 2023; 53:7222-7231. [PMID: 37078394 PMCID: PMC10719673 DOI: 10.1017/s0033291723000740] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 02/28/2023] [Accepted: 03/06/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND The 22q11.2 deletion (22q11Del) is among the strongest known genetic risk factors for psychosis. Stress, a known risk factor for psychosis in the general population, has seldom been studied in 22q11Del. We investigated how lifetime stressors related to symptomatic outcomes in patients with 22q11Del. We also explored this association in individuals with 22q11.2 duplications (22q11Dup), which may be potentially protective against psychosis. METHOD One hundred individuals (46 with 22q11Del, 30 with 22q11Dup, and 24 healthy controls; Mage = 17.30 years±10.15) were included. Logistic models were used to examine cross-sectional associations between lifetime acute and chronic stressors (severity and count) and the presence (score ⩾3) of positive, negative, and general symptoms, assessed via the Structured Interview for Psychosis-risk Syndromes (SIPS). RESULTS The 22q11Dup group reported the greatest number and severity of acute lifetime stressors, but did not differ from 22q11Del in chronic stressor count or severity. Lifetime chronic and acute stressors were uniquely associated with positive symptoms in 22q11Del (chronic count: odds ratio [OR] = 2.35, p = 0.02; chronic severity: OR = 1.88, p = 0.03; acute count: OR = 1.78, p = 0.03), but not with negative or general symptoms (ps > 0.05). CONCLUSION Findings suggest that stress may play a role in psychotic symptoms in 22q1Del, while the 22q11Dup CNV appears protective against psychotic symptoms despite higher rates of stressors. Interventions that mitigate effects of stressors in 22qDel may reduce the odds of psychosis in this group. Prospective longitudinal research is needed to replicate these findings.
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Affiliation(s)
- Jasmine Modasi
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vahe Khachadourian
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kathleen O'Hora
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
- Interdepartmental Program for Neuroscience, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Leila Kushan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - George M. Slavich
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Grant S. Shields
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, USA
| | - Eva Velthorst
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carrie E. Bearden
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Psychology, University of California, Los Angeles, CA, USA
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Khachadourian V, Mahjani B, Sandin S, Kolevzon A, Buxbaum JD, Reichenberg A, Janecka M. Comorbidities in autism spectrum disorder and their etiologies. Transl Psychiatry 2023; 13:71. [PMID: 36841830 PMCID: PMC9958310 DOI: 10.1038/s41398-023-02374-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/09/2023] [Accepted: 02/17/2023] [Indexed: 02/27/2023] Open
Abstract
Individuals with autism spectrum disorder (ASD), in addition to the core features of the disease, experience a higher burden of co-occurring medical conditions. This study sought to describe the frequency and distribution of comorbidit conditions in individuals with ASD, and systematically evaluate the possibility that pre- and postnatal exposures (e.g., preterm birth, hypoxia at birth, traumatic brain injury, and fetal alcohol syndrome) associated with ASD may also be linked with distinct comorbidities. We used the SPARK study database, launched by the Simons Foundation Autism Research Initiative (SFARI). Comorbidities considered in the study included neurological, cognitive, psychiatric, and physical conditions. The study sample consisted of 42,569 individuals with ASD and their 11,389 non-ASD siblings (full and half siblings). Majority (74%) of individuals with ASD had at least one comorbidity, and had a greater average number of comorbidities than their non-ASD siblings. Preterm birth and hypoxia at birth were the most common peri-natal exposures in the sample. In logistic regression models adjusted for covariates, these exposures were associated with several distinct comorbidities in ASD cases, including attention and behavior problems, psychiatric and neurological disorders, and growth conditions. A similar pattern of association was also observed in non-ASD siblings. Our findings underscore that individuals with ASD experience a greater burden of comorbidities, which could be partly attributable to the higher rates of perinatal exposures compared to their non-ASD siblings. Study findings, if replicated in other samples, can inform the etiology of comorbidity in ASD.
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Affiliation(s)
- Vahe Khachadourian
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Behrang Mahjani
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sven Sandin
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexander Kolevzon
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joseph D Buxbaum
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Abraham Reichenberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Magdalena Janecka
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Genetic and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Khachadourian V, Kodesh A, Levine SZ, Lin E, Buxbaum JD, Bergink V, Sandin S, Reichenberg A, Janecka M. Somatic comorbidities of mental disorders in pregnancy. Eur Psychiatry 2023; 66:e15. [PMID: 36645097 PMCID: PMC9970155 DOI: 10.1192/j.eurpsy.2023.1] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 12/03/2022] [Accepted: 12/06/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Mental and physical health conditions are frequently comorbid. Despite the widespread physiological and behavioral changes during pregnancy, the pattern of comorbidities among women in pregnancy is not well studied. This study aimed to systematically examine the associations between mental and somatic disorders before and during pregnancy. METHOD The study used data from mothers of a nationally representative birth cohort of children born in Israel (1997-2008). We compared the risk of all major somatic disorders (International Classification of Diseases, Ninth Revision) in pregnant women with and without a mental disorder. All analyses were adjusted for maternal age, child's birth year, family socioeconomic status, and the total number of maternal encounters with health services around pregnancy period. RESULTS The analytical sample included 77,030 mother-child dyads, with 30,083 unique mothers. The mean age at child's birth was 29.8 years. Prevalence of diagnosis of mental disorder around pregnancy in our sample was 4.4%. Comorbidity between mental and somatic disorders was two times higher than the comorbidity between pairs of different somatic disorders. Of the 17 somatic disorder categories, seven were positively associated with mental health disorders. The highly prevalent comorbidities associated with mental disorders in pregnancy included e.g. musculoskeletal (OR = 1.30; 95% CI = 1.20-1.42) and digestive system diseases (OR = 1.23; 95% CI = 1.13-1.34). CONCLUSIONS We observed that associations between maternal diagnoses and mental health stand out from the general pattern of comorbidity between nonmental health diseases. The study results confirm the need for screening for mental disorders during pregnancy and for potential comorbid conditions associated with mental disorders.
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Affiliation(s)
- Vahe Khachadourian
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
| | - Arad Kodesh
- The School of Public Health, University of Haifa, Haifa, Israel
- Meuhedet Health Services, Tel Aviv, Israel
| | | | - Emma Lin
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
| | - Joseph D. Buxbaum
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
| | - Veerle Bergink
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
- Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
| | - Sven Sandin
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Abraham Reichenberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
| | - Magdalena Janecka
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
- Department of Genetic and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
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Musheghyan L, Sahakyan S, Sargsyan Z, Muradyan D, Aslanyan L, Gharibyan N, Harutyunyan A, Khachadourian V, Petrosyan V. Predictors of seropositivity against SARS-COV-2: a population-based seroepidemiological study. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Data on parameters of actual exposure to SARS-CoV-2 is limited, and specific population groups might be at a higher risk of infection. In line with the growing need for large-scale investigations to determine the presence of antibodies against SARS-CoV-2 among different population groups, we conducted a nationwide assessment in Armenia.
Methods
We performed a cross-sectional seroepidemiological study among the adult population in Armenia, in May-September 2021. A multi-stage cluster random sampling was performed to recruit the participants across the capital city and regions. The study had two main components: blood sampling, which took place in primary care facilities and a phone survey on socio-demographic characteristics, comorbidities, and previous history of COVID-19.
Results
The number of participants included in both blood sampling and phone survey was 3483. The nationwide prevalence of SARS-CoV 2 antibodies weighted by age and gender was 66.4% with significantly higher prevalence in urban compared to rural areas (67.3% vs 59.3%, p < 0.001). Only 22.7% (n = 772) of the total sample reported a previous history of PCR confirmed COVID-19, among whom antibodies were detected in 94.2% (n = 727). In the final adjusted model, the seropositivity was associated with being female (OR = 1.60, 95% CI: 1.32; 1.92), employed (OR = 1.41, 95% CI: 1.17; 1.69), and having previous PCR confirmed COVID-19 (OR = 10.6, 95% CI: 7.39; 15.21).
Conclusions
Over 66% of the population were seropositive for antibodies against SARS-CoV 2; and over ⅕ of the sample reported a previous PCR diagnosis. Factors associated with increased odds of seropositivity included gender, employment status, and place of residence. Targeted interventions are recommended to minimize the risk of infection among those groups, including vaccination and infection prevention and control measures.
Key messages
• The prevalence of SARS-CoV 2 antibodies is about three times higher than the rate of infection based on PCR confirmed prevalence of COVID-19.
• Women, people living in urban areas, and those employed are at a higher risk for exposure to SARS-CoV 2.
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Affiliation(s)
- L Musheghyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - S Sahakyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - Z Sargsyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - D Muradyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - L Aslanyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - N Gharibyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - A Harutyunyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - V Khachadourian
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - V Petrosyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
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Sahakyan S, Musheghyan L, Muradyan D, Sargsyan Z, Petrosyan V, Khachadourian V, Harutyunyan A. The impact of smoking on immunological response to SARS-COV 2: a nationwide seroepidemiological study. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Smoking influences cellular and humoral immune responses and affects the immune system by increasing inflammation and decreasing activity against infections. The current study investigates the association between smoking and immunological response to SARS-CoV-2 in the Armenian population.
Methods
We performed a nationwide cross-sectional seroepidemiological study among the adult population (≥18 years old) in Armenia. We used a multi-stage cluster random sampling to recruit participants from the capital city and all regions of Armenia. We invited selected participants to primary healthcare facilities to provide blood samples for antibody testing followed by a phone survey on demographic characteristics, smoking status, and other variables. Logistic regression analysis was used to test the relationship between smoking and having SARS-CoV-2 antibodies adjusted for other covariates.
Results
3483 people participated in the study (71% women). The total sample included 16.8% current smokers (n = 571), 8.6% past smokers (n = 294) and 76.4% never smokers (n = 2538). The prevalence of SARS CoV-2 antibodies among current smokers was statistically significantly lower as compared with never smokers (46.9% vs 73.4%, p-value<0.001). In the multivariable logistic regression model, the odds of having SARS CoV-2 antibodies among the current smokers was 70% lower (OR 0.30, 95%CI: 0.22; 0.40) compared to never smokers, when adjusted for demographic factors and the time of PCR diagnosis of COVID-19. No statistically significant difference was found between past smokers and having SARS CoV-2 antibodies.
Conclusions
In addition to being a risk factor for various chronic diseases, smoking weakens immune response to infectious diseases, including COVID-19, worsening the outcomes. The significantly lower level of antibody prevalence among smokers with previous PCR confirmed COVID 19 implies a poorer immune response to the infection and not a lower risk of getting the infection.
Key messages
• Smoking weakens immune response and contributes to a higher burden of infectious diseases, such as COVID-19.
• Lower level of antibody prevalence among smokers indicates a poorer immune response to the infection rather than a lower risk of getting the infection.
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Affiliation(s)
- S Sahakyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - L Musheghyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - D Muradyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - Z Sargsyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - V Petrosyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - V Khachadourian
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - A Harutyunyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
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Khachadourian V, Zaks N, Lin E, Reichenberg A, Janecka M. Reprint of: Advanced paternal age and risk of schizophrenia in offspring - Review of epidemiological findings and potential mechanisms. Schizophr Res 2022; 247:84-91. [PMID: 36085274 DOI: 10.1016/j.schres.2022.08.023] [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: 02/27/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 11/28/2022]
Abstract
A large number of studies have examined the association between advanced paternal age (APA) and risk of schizophrenia in offspring. Here we present an overview of epidemiological studies on this subject published since 2000, and systematically summarize their methodologies and results. Next, we discuss evidence to elucidate the potential mechanisms contributing to the association between APA and offspring schizophrenia, considering paternal psychiatric morbidity and genetic liability, maternal factors, and findings from family design studies. We propose that multiple mechanisms, including causal and non-causal pathways, contribute to the observed relationship between APA and schizophrenia in offspring, and conclude by highlighting the need for multi-disciplinary studies in disentangling these complex, non-mutually exclusive mechanisms.
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Affiliation(s)
- Vahe Khachadourian
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
| | - Nina Zaks
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Emma Lin
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Abraham Reichenberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Magdalena Janecka
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
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Demirchyan A, Khachadourian V, Armenian HK, Goenjian AK. The course, trajectories and predictors of depression 23 years after the 1988 Spitak earthquake in Armenia: A prospective cohort study. Psychiatry Res 2022; 313:114640. [PMID: 35598565 DOI: 10.1016/j.psychres.2022.114640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/21/2022] [Revised: 05/04/2022] [Accepted: 05/14/2022] [Indexed: 11/19/2022]
Abstract
There is a scarcity of long-term studies of depression after natural disasters. This prospective epidemiologic study evaluated the course of depression and factors associated with it among survivors 23-years post-earthquake. A geographically stratified subsample of 725 adults exposed to the Spitak earthquake was assessed for depression using DSM-III-R criteria in 1991 and 2012. Additionally, an adapted CES-D-16 scale was used to assess depressive symptoms in 2012. A fitted multi-nominal logistic regression model identified predictors of different trajectories of depression. For the whole group, the rate of clinical depression dropped from 51.5% in 1991 to 31.7% in 2012. Earthquake intensity and experiencing strong fear at baseline were strongly associated with chronic (depressed at both assessments, 18.1%) and recovered (depressed only in 1991, 33.5%) depression trajectories compared with the healthy group, with odds ratios (OR) over 4.0 and 3.0, respectively. Predictors distinguishing chronic depression included earthquake-related nuclear-family deaths (OR=3.79), chronic illnesses at baseline (OR=1.24), and social support (OR=0.91). Predictors of the late-onset trajectory (depressed only in 2012, 13.5% of the cohort) included post-earthquake trauma (OR=1.42), socioeconomic status (OR=0.45), and social support (OR=0.86). The factors associated with the different trajectories of depression provide guidance for planning more effective mental health interventions after disasters.
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Affiliation(s)
- Anahit Demirchyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia.
| | - Vahe Khachadourian
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Haroutune K Armenian
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Armen K Goenjian
- UCLA/Duke University National Center for Child Traumatic Stress, Department of Psychiatry and Biobehavioral Sciences, UCLA, CA, USA; Collaborative Neuroscience Network, CA, USA
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Markosian C, Layne CM, Petrosyan V, Shekherdimian S, Kennedy CA, Khachadourian V. War in the COVID-19 era: Mental health concerns in Armenia and Nagorno-Karabakh. Int J Soc Psychiatry 2022; 68:481-483. [PMID: 33736534 DOI: 10.1177/00207640211003940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Christopher M Layne
- University of California, Los Angeles-Duke University National Center for Child Traumatic Stress, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - Varduhi Petrosyan
- Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, Yerevan, AM
| | - Shant Shekherdimian
- Division of Pediatric Surgery, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - Cheryl A Kennedy
- Department of Psychiatry, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Vahe Khachadourian
- Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, Yerevan, AM.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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11
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Balalian AA, Daniel S, Simonyan H, Khachadourian V. Comparison of Conditional and Marginal Models in Assessing a Child Nutrition Intervention in Armenia. Matern Child Health J 2022; 26:1358-1366. [PMID: 34997434 DOI: 10.1007/s10995-021-03308-y] [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] [Accepted: 11/22/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Child malnutrition is a major issue in conflict zones. Evidence-based interventions and their thorough evaluation could help to eliminate malnutrition. We aimed to assess the causal effect of a community-based multidisciplinary nutrition program for children in a chronic conflict zone near the northeastern border of Armenia on two main outcomes: stunting and anemia. We further compared the interpretations and public health relevance of the obtained effect estimates. METHODS In 2016, the study measured hemoglobin and anthropometric measures and collected data from the children's caregivers. We used propensity score matching analyses, inverse probability weighting, and overlap weighting methods to examine the average treatment effects among treated population (ATT), and among population with overlapping weights (ATO). RESULTS The ATT for stunting among children who participated in the intervention program estimated by propensity score matching analyses (PSM-ATT) was (1.95; 95%CI 1.15-3.28). Nevertheless, children who took part in the program had a lower risk of anemia (0.28; 95%CI 0.19-0.42). The ATT, estimated by inverse probability weighting (IPTW-ATT), was slightly lower for stunting (1.82; 95%CI 1.16-2.86) while similar for anemia (0.33; 95%CI 0.23-0.46) compared to PSM-ATT. Compared to the IPTW-ATT and PSM-ATT the ATO was lower for stunting (1.75; 95%CI 1.14-2.68) and similar for anemia (0.31; 95%CI 0.22-0.43). DISCUSSION Marginal models could be used in similar quasi-experimental settings to identify the causal effect of interventions in specific populations of interest. Nonetheless, these methods do not eliminate threats to internal validity. Thorough study design and accurate data collection are necessary to improve the efficiency of marginal models.
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Affiliation(s)
- Arin A Balalian
- Mailman School of Public Health, Columbia University, 722 West 168th St., New York, NY, USA.
| | - Sharon Daniel
- Department of Public Health and Pediatrics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | - Vahe Khachadourian
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, USA
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Bohra C, Khachadourian V, Vogel B, Leis P, Correa A, Sud K, Govindarajulu U, Narula J, Argulian E. Comparison of Handheld Ultrasound Assisted Physical Examination to Physical Examination Alone in Detecting Isolated Severe Tricuspid Regurgitation. J Am Soc Echocardiogr 2022; 35:525-527. [PMID: 34998965 DOI: 10.1016/j.echo.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 12/31/2021] [Accepted: 01/01/2022] [Indexed: 11/25/2022]
Affiliation(s)
| | - Vahe Khachadourian
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Birgit Vogel
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Paul Leis
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ashish Correa
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Karan Sud
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Usha Govindarajulu
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jagat Narula
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Edgar Argulian
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY.
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Inoue K, Nianogo R, Telesca D, Goto A, Khachadourian V, Tsugawa Y, Sugiyama T, Mayeda ER, Ritz B. Low HbA1c levels and all-cause or cardiovascular mortality among people without diabetes: the US National Health and Nutrition Examination Survey 1999-2015. Int J Epidemiol 2021; 50:1373-1383. [PMID: 33378417 DOI: 10.1093/ije/dyaa263] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE It is unclear whether relatively low glycated haemoglobin (HbA1c) levels are beneficial or harmful for the long-term health outcomes among people without diabetes. We aimed to investigate the association between low HbA1c levels and mortality among the US general population. METHODS This study includes a nationally representative sample of 39 453 US adults from the National Health and Nutrition Examination Surveys 1999-2014, linked to mortality data through 2015. We employed the parametric g-formula with pooled logistic regression models and the ensemble machine learning algorithms to estimate the time-varying risk of all-cause and cardiovascular mortality by HbA1c categories (low, 4.0 to <5.0%; mid-level, 5.0 to <5.7%; prediabetes, 5.7 to <6.5%; and diabetes, ≥6.5% or taking antidiabetic medication), adjusting for 72 potential confounders including demographic characteristics, lifestyle, biomarkers, comorbidities and medications. RESULTS Over a median follow-up of 7.5 years, 5118 (13%) all-cause deaths, and 1116 (3%) cardiovascular deaths were observed. Logistic regression models and machine learning algorithms showed nearly identical predictive performance of death and risk estimates. Compared with mid-level HbA1c, low HbA1c was associated with a 30% (95% CI, 16 to 48) and a 12% (95% CI, 3 to 22) increased risk of all-cause mortality at 5 years and 10 years of follow-up, respectively. We found no evidence that low HbA1c levels were associated with cardiovascular mortality risk. The diabetes group, but not the prediabetes group, also showed an increased risk of all-cause mortality. CONCLUSIONS Using the US national database and adjusting for an extensive set of potential confounders with flexible modelling, we found that adults with low HbA1c were at increased risk of all-cause mortality. Further evaluation and careful monitoring of low HbA1c levels need to be considered.
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Affiliation(s)
- Kosuke Inoue
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Roch Nianogo
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Donatello Telesca
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Atsushi Goto
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama, Japan
| | - Vahe Khachadourian
- Gerald & Patricia Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Takehiro Sugiyama
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Beate Ritz
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA.,Department of Environmental Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA.,Department of Neurology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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14
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Giloyan A, Muradyan D, Khachadourian V. Visual impairment and associated risk factors in patients with diabetes mellitus in Tavush and Armavir provinces of Armenia. Int Ophthalmol 2021; 42:47-56. [PMID: 34379291 DOI: 10.1007/s10792-021-01998-5] [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: 11/13/2020] [Accepted: 07/30/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Visual impairment (VI) and blindness remain serious public health problems among patients with diabetes. This study assessed the prevalence of VI and its associated risk factors in individuals with diabetes mellitus (DM) in Armenia. METHODS This cross-sectional study recruited 1287 people with DM. All participants underwent comprehensive ophthalmic examination and responded to a structured questionnaire on sociodemographic and health characteristics, health-seeking behavior, and ocular health. The presence of eye diseases and VI was defined based on the International Classification of Diseases-11. Descriptive statistics and logistic regression were used to address the study objectives. RESULTS The mean age of participants was 61.5 (SD = 9.6) ranging from 19.4 to 99.8 years. The mean duration of diabetes was 7.4 years. The majority of participants (70.5%) were women. The prevalence of VI and blindness was 12.1% and 0.9%, respectively. Overall, 22.4% of participants had diabetic retinopathy. In the adjusted analysis, advanced age (OR = 1.08; 95%CI: 1.06-1.11), higher education (OR = 0.37; 95%CI: 0.19-0.74), diabetes duration (OR = 1.05; 95%CI: 1.02-1.08), the presence of diabetic retinopathy (OR = 3.61; 95%CI: 2.38-5.46), age-related macular degeneration (OR = 1.88; 95%CI: 1.15-3.05), cataract (OR = 2.45; 95%CI: 1.66-3.63), and glaucoma (OR = 2.32; 95%CI: 1.25-4.30) were associated with VI. CONCLUSION The findings highlight the importance and need for regular eye screening and diabetes prevention programs in the country. Continuous educational programs on diabetes self-management among patients with DM can reduce complications of diabetes including vision loss due to diabetes.
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Affiliation(s)
- Aida Giloyan
- Turpanjian School of Public Health, Garo Meghrigian Institute for Preventive Ophthalmology, American University of Armenia, 40 Marshal Baghramian Ave., 0019, Yerevan, Armenia.
| | - Diana Muradyan
- Turpanjian School of Public Health, American University of Armenia, 40 Marshal Baghramian Ave, 0019, Yerevan, Armenia
| | - Vahe Khachadourian
- Turpanjian School of Public Health, American University of Armenia, 40 Marshal Baghramian Ave, 0019, Yerevan, Armenia
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15
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Khachadourian V, Zaks N, Lin E, Reichenberg A, Janecka M. Advanced paternal age and risk of schizophrenia in offspring - Review of epidemiological findings and potential mechanisms. Schizophr Res 2021; 233:72-79. [PMID: 34242951 PMCID: PMC8380724 DOI: 10.1016/j.schres.2021.06.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 02/27/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 12/30/2022]
Abstract
A large number of studies have examined the association between advanced paternal age (APA) and risk of schizophrenia in offspring. Here we present an overview of epidemiological studies on this subject published since 2000, and systematically summarize their methodologies and results. Next, we discuss evidence to elucidate the potential mechanisms contributing to the association between APA and offspring schizophrenia, considering paternal psychiatric morbidity and genetic liability, maternal factors, and findings from family design studies. We propose that multiple mechanisms, including causal and non-causal pathways, contribute to the observed relationship between APA and schizophrenia in offspring, and conclude by highlighting the need for multi-disciplinary studies in disentangling these complex, non-mutually exclusive mechanisms.
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Affiliation(s)
- Vahe Khachadourian
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
| | - Nina Zaks
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Emma Lin
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Abraham Reichenberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Magdalena Janecka
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
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16
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A Balalian A, Berberian A, Chiloyan A, DerSarkissian M, Khachadourian V, Siegel EL, Mehranbod C, Hovsepian V, Deckelbaum RJ, Factor-Litvak P, Daniel S, Shafir S, Dorian A, Hekimian K. War in Nagorno-Karabakh highlights the vulnerability of displaced populations to COVID-19. J Epidemiol Community Health 2021; 75:605-607. [PMID: 33674457 DOI: 10.1136/jech-2020-216370] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/09/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Arin A Balalian
- Department of Epidemiology, Columbia University, New York, New York, USA
| | - Alique Berberian
- Department of Environmental Health Sciences, University of California Los Angeles, Los Angeles, California, USA
| | | | - Maral DerSarkissian
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, USA
| | - Vahe Khachadourian
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Eva Laura Siegel
- Department of Epidemiology, Columbia University, New York, New York, USA
| | | | - Vaneh Hovsepian
- School of Nursing, Columbia University, New York, New York, USA
| | | | - Pam Factor-Litvak
- Department of Epidemiology, Columbia University, New York, New York, USA
| | - Sharon Daniel
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shira Shafir
- Department of Community Health Sciences, University of California Los Angeles, Los Angeles, California, USA
| | - Alina Dorian
- Department of Community Health Sciences, University of California Los Angeles, Los Angeles, California, USA
| | - Kim Hekimian
- Institute of Human Nutrition, Columbia University, New York, New York, USA
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17
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Kodesh A, Levine SZ, Khachadourian V, Rahman R, Schlessinger A, O’Reilly PF, Grove J, Schendel D, Buxbaum JD, Croen L, Reichenberg A, Sandin S, Janecka M. Maternal health around pregnancy and autism risk: a diagnosis-wide, population-based study. Psychol Med 2021; 52:1-9. [PMID: 33766168 PMCID: PMC8464612 DOI: 10.1017/s0033291721001021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Many studies have reported an increased risk of autism spectrum disorder (ASD) associated with some maternal diagnoses in pregnancy. However, such associations have not been studied systematically, accounting for comorbidity between maternal disorders. Therefore our aim was to comprehensively test the associations between maternal diagnoses around pregnancy and ASD risk in offspring. METHODS This exploratory case-cohort study included children born in Israel from 1997 to 2008, and followed up until 2015. We used information on all ICD-9 codes received by their mothers during pregnancy and the preceding year. ASD risk associated with each of those conditions was calculated using Cox proportional hazards regression, adjusted for the confounders (birth year, maternal age, socioeconomic status and number of ICD-9 diagnoses during the exposure period). RESULTS The analytic sample consisted of 80 187 individuals (1132 cases, 79 055 controls), with 822 unique ICD-9 codes recorded in their mothers. After extensive quality control, 22 maternal diagnoses were nominally significantly associated with offspring ASD, with 16 of those surviving subsequent filtering steps (permutation testing, multiple testing correction, multiple regression). Among those, we recorded an increased risk of ASD associated with metabolic [e.g. hypertension; HR = 2.74 (1.92-3.90), p = 2.43 × 10-8], genitourinary [e.g. non-inflammatory disorders of cervix; HR = 1.88 (1.38-2.57), p = 7.06 × 10-5] and psychiatric [depressive disorder; HR = 2.11 (1.32-3.35), p = 1.70 × 10-3] diagnoses. Meanwhile, mothers of children with ASD were less likely to attend prenatal care appointment [HR = 0.62 (0.54-0.71), p = 1.80 × 10-11]. CONCLUSIONS Sixteen maternal diagnoses were associated with ASD in the offspring, after rigorous filtering of potential false-positive associations. Replication in other cohorts and further research to understand the mechanisms underlying the observed associations with ASD are warranted.
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Affiliation(s)
- Arad Kodesh
- Department of Community Mental Health, University of Haifa, Haifa, Israel
- Meuhedet Health Services, Tel Aviv, Israel
| | - Stephen Z. Levine
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Vahe Khachadourian
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rayees Rahman
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Avner Schlessinger
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Paul F. O’Reilly
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jakob Grove
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- iSEQ, Centre for Integrative Sequencing, Aarhus University, Aarhus, Denmark
- Department of Biomedicine—Human Genetics, Aarhus University, Aarhus, Denmark
- Bioinformatics Research Centre, Aarhus University, Aarhus, Denmark
| | - Diana Schendel
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Section for Epidemiology, National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Joseph D. Buxbaum
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, New York
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lisa Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Abraham Reichenberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, New York
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sven Sandin
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Magdalena Janecka
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Biomedicine—Human Genetics, Aarhus University, Aarhus, Denmark
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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18
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Shah R, Assis F, Narasimhan B, Khachadourian V, Zhou S, Tandri H, Tariq N. Trans-nasal high-flow dehumidified air in acute migraine headaches: A randomized controlled trial. Cephalalgia 2021; 41:968-978. [PMID: 33631965 DOI: 10.1177/0333102421997766] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Intranasal high flow of dehumidified (dry) air results in evaporative cooling of nasal passages. In this randomized clinical trial, we investigated the effect of dry gas induced nasal cooling on migraine headaches. METHODS In this single-blind study, acute migraineurs were randomized to either nasal high-flow dry oxygen, dry air, humidified oxygen or humidified air (control) at 15 L/min for 15 min. All gases were delivered at 37°C. Severity of headache and other migraine associated symptoms (International Classification for Headache Disorders, 3rd edition criteria) were recorded before and after therapy. The primary endpoint was change in pain scores, while changes in nausea, photosensitivity and sound sensitivity scores served as secondary endpoints. A linear regression model was employed to estimate the impact of individual treatment components and their individual interactions. RESULTS Fifty-one patients (48 ± 15 years of age, 82% women) were enrolled. When compared to the control arm (humidified air), all therapeutic arms showed a significantly greater reduction in pain scores (primary endpoint) at 2 h of therapy with dry oxygen (-1.6 [95% CI -2.3, -0.9]), dry air (-1.7 [95% CI -2.6, -0.7)]), and humidified oxygen (-2.3 [95% CI -3.5, -1.1]). A significantly greater reduction in 2-h photosensitivity scores was also noted in all therapeutic arms (-1.8 [95% CI -3.2, -0.4], dry oxygen; -1.7 [95% CI -2.9, -0.4], dry air; (-2.1 [95% CI -3.6, -0.6], humidified oxygen) as compared to controls. The presence of oxygen and dryness were independently associated with significant reductions in pain and photosensitivity scores. No adverse events were reported. CONCLUSION Trans-nasal high-flow dry gas therapy may have a role in reducing migraine associated pain.Clinical Trial registration: NCT04129567.
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Affiliation(s)
- Rushil Shah
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fabrizio Assis
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bharat Narasimhan
- Department of Internal Medicine, Mount Sinai St. Lukes-Roosevelt, New York, NY, USA
| | - Vahe Khachadourian
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Shijie Zhou
- Alliance for Cardiovascular Diagnostic and Treatment Innovation (ADVANCE), Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Harikrishna Tandri
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nauman Tariq
- Division of Neurology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Markosian C, Khachadourian V, Kennedy CA. Frozen conflict in the midst of a global pandemic: potential impact on mental health in Armenian border communities. Soc Psychiatry Psychiatr Epidemiol 2021; 56:513-517. [PMID: 33388798 PMCID: PMC7778713 DOI: 10.1007/s00127-020-01996-5] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/25/2020] [Indexed: 11/09/2022]
Abstract
Armenia has been in a conflict with its neighbor, Azerbaijan, since 1988. Civilians in Tavush Province are regularly affected by ceasefire violations along the armed border with recent escalations further threatening the population's safety. In the midst of the COVID-19 pandemic, concerns regarding the mental health of border village residents in Armenia are prevalent. We present context-related factors of psychiatric illness, the prevalence of mental health disorders, and the state of mental health services in Armenia. We recommend directing greater attention towards the mental health status of civilians residing in conflict zones during the ongoing COVID-19 pandemic.
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Affiliation(s)
- Christopher Markosian
- Department of Psychiatry, Rutgers New Jersey Medical School, 183 South Orange Avenue, Newark, NJ, 07103, USA.
| | - Vahe Khachadourian
- grid.78780.300000 0004 0613 1044Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, Yerevan, Republic of Armenia
| | - Cheryl A. Kennedy
- grid.430387.b0000 0004 1936 8796Department of Psychiatry, Rutgers New Jersey Medical School, 183 South Orange Avenue, Newark, NJ 07103 USA
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Giloyan A, Khachadourian V, Petrosyan V, Harutyunyan T. Prevalence and determinants of uncorrected refractive error among a socially vulnerable older adult population living in Armenia. Public Health 2020; 190:30-36. [PMID: 33338900 DOI: 10.1016/j.puhe.2020.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/06/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study estimated the prevalence of uncorrected refractive error (URE) and its determinants in a socially vulnerable older population living in Armenia. STUDY DESIGN The study design used in the stidy is a cross-sectional study. METHODS A total of 485 people responded to a survey on sociodemographic characteristics, spectacle use, and ophthalmic services' use. All participants underwent a comprehensive ophthalmic examination including assessment of presenting and best-corrected visual acuity, measuring intraocular pressure and dilated eye fundus examination. Patients who had presenting visual acuity (<6/12) but improved ≥ one line with/without available spectacles after refraction in the better eye were considered to have URE. Descriptive statistics described the sample and estimated the prevalence of the URE in the population. Logistic regression models were used to evaluate its determinants. RESULTS The mean age of participants was 74.5 (7.27) years, ranging from 51 to 94 years. Women constituted the majority of participants (86%). The prevalence of URE in the better eye was 26%. In bivariate analysis, those who were older and who had less than 10 years of education had higher odds of URE than younger and more educated respondents. In multivariable analysis, only education remained associated with URE (OR = 3.71; 95% CI: 1.10-12.5). The rate of normal vision (≥6/12) improved from 58.9% to 81.5%, whereas the rate of visual impairment (<6/12) decreased from 41.1% to 18.5% after best correction in the better eye. CONCLUSION The prevalence of URE was high in this study population. The findings warrant the need for eye screening and provision of affordable spectacle correction to the target population in Armenia.
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Affiliation(s)
- A Giloyan
- Garo Meghrigian Institute for Preventive Ophthalmology, Turpanjian School of Public Health, American University of Armenia, 40 Marshal Baghramian Ave., Yerevan, 0019, Armenia.
| | - V Khachadourian
- Turpanjian School of Public Health, American University of Armenia, 40 Marshal Baghramian Ave., Yerevan, 0019, Armenia.
| | - V Petrosyan
- Turpanjian School of Public Health, American University of Armenia, 40 Marshal Baghramian Ave., Yerevan, 0019, Armenia.
| | - T Harutyunyan
- Turpanjian School of Public Health, American University of Armenia, 40 Marshal Baghramian Ave., Yerevan, 0019, Armenia.
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Khachatoorian Y, Khachadourian V, Chang E, Sernas ER, Reed EF, Deng M, Piening BD, Pereira AC, Keating B, Cadeiras M. Noninvasive biomarkers for prediction and diagnosis of heart transplantation rejection. Transplant Rev (Orlando) 2020; 35:100590. [PMID: 33401139 DOI: 10.1016/j.trre.2020.100590] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 07/19/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 01/12/2023]
Abstract
For most patients with end-stage heart failure, heart transplantation is the treatment of choice. Allograft rejection is one of the major post-transplantation complications affecting graft outcome and survival. Recent advancements in science and technology offer an opportunity to integrate genomic and other omics-based biomarkers into clinical practice, facilitating noninvasive evaluation of allograft for diagnostic and prognostic purposes. Omics, including gene expression profiling (GEP) of blood immune cell components and donor-derived cell-free DNA (dd-cfDNA) are of special interest to researchers. Several studies have investigated levels of dd-cfDNA and miroRNAs in blood as potential markers for early detection of allograft rejection. One of the achievements in the field of transcriptomics is AlloMap, GEP of peripheral blood mononuclear cells (PBMC), which can identify 11 differentially expressed genes and help with detection of moderate and severe acute cellular rejection in stable heart transplant recipients. In recent years, the utilization of GEP of PBMC for identifying differentially expressed genes to diagnose acute antibody-mediated rejection and cardiac allograft vasculopathy has yielded promising results. Advancements in the field of metabolomics and proteomics as well as their potential implications have been further discussed in this paper.
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Affiliation(s)
- Yeraz Khachatoorian
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
| | - Vahe Khachadourian
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Eleanor Chang
- Division of Cardiology, David Geffen School of Medicine, Los Angeles, CA, United States of America
| | - Erick R Sernas
- Division of Cardiovascular Medicine, University of California Davis, Davis, CA, United States of America
| | - Elaine F Reed
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, United States of America
| | - Mario Deng
- Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles, CA, United States of America
| | - Brian D Piening
- Earle A Chiles Research Institute, Providence Health and Services, Portland, OR, United States of America
| | | | - Brendan Keating
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Martin Cadeiras
- Division of Cardiovascular Medicine, University of California Davis, Davis, CA, United States of America
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Sahakyan S, Musheghyan L, Harutyunyan A, Khachadourian V. Moving towards people–centered approach in TB Health Care System: Armenia’s Experience. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Achieving integrated people-centered care requires interventions at various levels of the system, including policy changes and measures tailored to strengthen skills and competencies of health care providers. The national guidelines for TB care provision in Armenia provide a standardized approach for TB diagnosis and treatment, including systematic implementation of TB care services across the country. Before August 2019, the only option for drug-sensitive TB treatment was facility-based DOT.
Methods
In order to offer an alternative treatment option- family- based DOT, and bring TB services closer to patients' needs and values, the national guideline for TB care provision was updated to institutionalize the new approach. A series of nationwide professional development trainings was launched to assure that health care providers at the inpatient and outpatient settings effectively follow the new updates in the national guideline. These evidence-based trainings specifically aimed to equip healthcare providers with the necessary tools, knowledge, and the skillset for communicating with TB patients and building relationship and trust, offering their professional support. Along with patient counselling skills, the curriculum covered recent updates on TB epidemic, its social-psychological and behavioral risk factors, and advancements in TB diagnosis and treatment. All the participants were provided with a manual and other materials regarding the program.
Results
The Ministry of Health of the RA has approved the national guidelines on TB care (No 2277 - Ô±, August 19). This document includes information on people-centered TB treatment and institutionalizes the family-based DOT in Armenia. More than 90 percent of TB healthcare providers (98 physicians and 134 nurses) throughout Armenia participated in the trainings and received certificates. The RA Ministry of Health accredited the training curriculum with 11 continuing medical education credits for participation.
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Affiliation(s)
- S Sahakyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - L Musheghyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - A Harutyunyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - V Khachadourian
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
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Musheghyan L, Sahakyan S, Harutyunyan A, Khachadourian V. Integrating psycho–social counselling in TB Services in Armenia. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Community or family-based DOT improves clinical outcomes and quality of life of TB patients compared to facility-based DOT. Based on a previously conducted clinical trial and recommended best practice guidelines, Armenia started the institutionalization of the family-based DOT in 2019, as an important component of the integrated people-centered approach in TB treatment. Psycho-social counselling and education played a crucial role in preparing patients/family members for this new model of care.
Methods
To facilitate the family-based DOT, multidisciplinary counseling teams consisting of a TB nurse and a psychologist or a TB nurse and a social worker were formed and further incorporated into the existing TB care system. After a systematic evaluation the strongest applicants were shortlisted, interviewed, and selected. They underwent a three-day training, improving their knowledge on TB disease, its transmission, diagnosis and treatment; patient counseling with an emphasis on motivational interviewing techniques; and people-centered TB care. A comprehensive package of procedural documents was developed to facilitate the counseling teams work process, including a guideline on counseling, reporting forms, and patients' educational materials. At an early stage of TB treatment, the counseling teams provide psycho-social counselling to patients and their families, and educate them on TB risk factors and infection control.
Results
The counselling teams have been based in the National Center of Pulmonology of the RA and provide psycho-social counselling to all drug susceptible TB patients and their family members all over Armenia. The counseling teams prepare patients/family members for the family-based DOT and provide continuous support during the entire treatment. The integration of counselling teams in the TB care system has provided the required human resource and capacity for the successful adoption of a new model of people-centered TB care in Armenia.
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Affiliation(s)
- L Musheghyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - S Sahakyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - A Harutyunyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - V Khachadourian
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
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Thomas MS, Demirchyan A, Khachadourian V. How Effective Is Iron Supplementation During Pregnancy and Childhood in Reducing Anemia Among 6-59 Months Old Children in India? Front Public Health 2020; 8:234. [PMID: 32733832 PMCID: PMC7359635 DOI: 10.3389/fpubh.2020.00234] [Citation(s) in RCA: 5] [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: 12/03/2019] [Accepted: 05/18/2020] [Indexed: 12/31/2022] Open
Abstract
Objectives: The study sought to identify whether iron and folic acid supplementation of pregnant women and preschool children is associated with child's anemia status and the predictors of anemia among children in India. Design: Secondary data analysis was performed using the National Family Health Survey 4 data. Multivariable logistic regression was used to identify the adjusted associations between child's anemia status and iron supplementation, both during pregnancy and childhood. Also, a model of significant predictors of anemia among children was fitted. Setting: India. Participants: Youngest children (6-59 months) in families. Results: The adjusted association between supplementation during pregnancy and child's anemia status was significant (p = 0.010), whereas the adjusted association between supplementation during childhood and child's anemia status was insignificant (p = 0.16). The variables independently associated with anemia status of the child included younger age (95% CI 2.67–2.86), child's recent diarrhea (95% CI 1.02–1.14), low birth weight (95% CI 1.17–1.27), current underweight (95% CI 1.14–1.28), diet diversity score (95% CI 0.96–0.98), higher birth order (95% CI 1.01–1.05), mother's current anemia (95% CI 1.68–1.81), months of breastfeeding (95% CI 0.99–1.00), no/primary education (95% CI 1.23–1.35), family's low wealth index (95% CI 1.11–1.23), and backward caste (95% CI 1.04–1.14). Conclusions: The National Iron Plus Initiative strategy of child's iron supplementation should be evaluated to identify the reasons of its ineffectiveness in anemia reduction. In addition, vulnerable groups of children, i.e., children from poor and less educated families and those with low birth weight, higher birth order, and poor nutritional status, should be targeted first with anemia reduction interventions.
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Affiliation(s)
- Monica Steffi Thomas
- Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Anahit Demirchyan
- Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Vahe Khachadourian
- Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
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Khachadourian V, Truzyan N, Harutyunyan A, Petrosyan V, Davtyan H, Davtyan K, van den Boom M, Thompson ME. People-centred care versus clinic-based DOT for continuation phase TB treatment in Armenia: a cluster randomized trial. BMC Pulm Med 2020; 20:105. [PMID: 32334553 PMCID: PMC7183136 DOI: 10.1186/s12890-020-1141-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 01/21/2020] [Accepted: 04/08/2020] [Indexed: 11/20/2022] Open
Abstract
Background WHO’s directly observed therapy (DOT) strategy for tuberculosis (TB) treatment depends upon a well–organized healthcare system. This study sought to evaluate the effectiveness of self-administered drug intake supported by a family member versus in-clinic DOT. Methods This open–label, nationally-representative stratified cluster randomized controlled non–inferiority trial with two parallel equal arms involved drug–susceptible pulmonary TB patients in the continuation treatment phase. We randomly assigned outpatient–TB–centres (52 clusters) to intervention and control arms. The intervention included an educational/counseling session to enhance treatment adherence; weekly visits to outpatient–TB–centres to receive medication, and daily SMS medication reminders and phone calls to track adherence and record side effects. Controls followed clinical DOT at Outpatient–TB–centres. Both groups participated in baseline and 4–5 months follow–up surveys. The trial’s non–inferiority comparisons include: treatment success as the clinical (primary) outcome and medication adherence (self–reported), knowledge, depressive symptoms, stigma, quality of life, and social support as non–clinical (secondary) outcomes. Results Per–protocol analysis showed that the intervention (n = 187) and control (n = 198) arms achieved successful treatment outcome of 92.0 and 92.9%, respectively, indicating that the treatment success in the intervention group was non–inferior to DOT. Knowledge, depression, stigma, quality of life, and social support also showed non–inferiority, demonstrating substantial improvement over time for knowledge (change in the intervention = 1.05: 95%CL (0.49, 1.60); change in the control = 1.09: 95%CL (0.56, 1.64)), depression score (change in the intervention = − 3.56: 95%CL (− 4.99, − 2.13); change in the control = − 1.88: 95% CL (− 3.26, − 0.49)) and quality of life (change in the intervention = 5.01: 95%CL (− 0.64, 10.66); change in the control = 7.29: 95%CL (1.77, 12.81)). The intervention resulted in improved treatment adherence. Conclusions This socially empowering alternative strategy might be a preferable alternative to DOT available to patients in Armenia and in other countries. Further research evaluating cost effectiveness of the intervention and generalizability of the results is warranted. Trial registration Clinicaltrials.gov: NCT02082340, March 10, 2014.
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Affiliation(s)
- Vahe Khachadourian
- Avedisian Onanian Centre for Health Services Research & Development, Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia. .,Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, USA.
| | - Nune Truzyan
- Avedisian Onanian Centre for Health Services Research & Development, Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Arusyak Harutyunyan
- Avedisian Onanian Centre for Health Services Research & Development, Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Varduhi Petrosyan
- Avedisian Onanian Centre for Health Services Research & Development, Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Hayk Davtyan
- National Tuberculosis Control Centre, Ministry of Health of the Republic of Armenia, Yerevan, Armenia
| | - Karapet Davtyan
- National Tuberculosis Control Centre, Ministry of Health of the Republic of Armenia, Yerevan, Armenia
| | - Martin van den Boom
- Joint Tuberculosis, HIV & Viral Hepatitis Programme, Division of Health Emergencies and Communicable Diseases, WHO/Europe, Copenhagen, Denmark
| | - Michael E Thompson
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, USA
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Abstract
Objectives: Back pain is the leading occupational health problem among agricultural workers. Current study aimed to assess the burden of farm work-related back pain and to investigate its associations with living residence location and work conditions among farmworkers. Methods: We used the National Agricultural Workers Survey (NAWS) data from 1999 to 2004, 2008-2010, and 2014. Work-related back pain was defined as a back pain that was developed when performing farm work in the 12 months prior to the interview, and it caused pain or discomfort for at least five consecutive days. To assess the associations of place of residence and working conditions (i.e. work equipment and access to toilet and water for washing hands at work) with back pain, we analyzed the data using mixed-effects logistic regression models while adjusting for age, gender, race, birthplace (US vs. foreign country), education, marital status, work authorization (yes vs. no), below poverty income, whether the worker was hired by a farm labor contractor or not, and weekly working hours. Results: The standardized annual back pain prevalence during the study period ranged from 2.6% to 11.3%. In the adjusted model, farmworkers who lived in a residence located on the farm, who did not have access to toilet at work, and who paid for work equipment had higher odds of back pain than their counterparts. Conclusion: Back pain is particularly common among farmworkers with poor working and living conditions. Interventions should target the identified high-risk groups to mitigate their burden of back pain.
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Affiliation(s)
- Vahe Khachadourian
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA) , Los Angeles, CA, USA
| | - Onyebuchi A Arah
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA) , Los Angeles, CA, USA.,UCLA Center for Health Policy Research , Los Angeles, CA, USA.,California Center for Population Research, UCLA , Los Angeles, CA, USA.,Department of Statistics, UCLA College of Letters and Science , Los Angeles, CA, USA
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Abstract
This population-based longitudinal study examined the rates and predictors of posttraumatic stress disorder (PTSD) among 725 differentially exposed survivors of the 1988 Spitak earthquake in Armenia, 23 years after the event. Participants had been previously evaluated in 1991. Evaluations included assessment of current PTSD (based on DSM-5 criteria), and a variety of potential risk and protective factors. For the whole sample, the rate of PTSD attributed to the earthquake decreased from 48.7% in 1991 to 11.6% in 2012 (p < .001). A "dose of exposure" pattern persisted, and 15.7% of participants who were in Spitak (high exposure) and 6.6% of participants who were in Kirovagan (low exposure) during the earthquake met the criteria for PTSD (p = .003). Additionally, in 2012, another 9.9% of participants met PTSD criteria due to post-earthquake traumas, which is a 5-fold increase from pre- to postearthquake (p < . 001). Factors positively associated with PTSD included earthquake-related job loss, exposure to post-earthquake traumas, depression at baseline, and chronic illness since the earthquake. Factors inversely associated with PTSD included housing assistance within two years after the earthquake, support of family and/or friends, and to a lesser degree, higher education and high living standard. These variables accounted for 23.1% of the variance in current PTSD severity scores. These findings indicate that PTSD rates subside significantly after a catastrophic disaster, although earthquake-related PTSD persists among a subgroup of exposed individuals. Predictors of PTSD identified in this study provide guidance for planning acute and longer-term postdisaster public mental health recovery programs.
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Affiliation(s)
- Armen K Goenjian
- UCLA/Duke University National Center for Child Traumatic Stress, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA
| | - Vahe Khachadourian
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
| | - Haroutune Armenian
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
| | - Anahit Demirchyan
- American University of Armenia Center for Health Services Research and Development, Yerevan, Armenia
| | - Alan M Steinberg
- UCLA/Duke University National Center for Child Traumatic Stress, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA
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Demirchyan A, Armenian HK, Khachadourian V, Goenjian AK, Petrosyan V. Prospective study of predictors of long-term mortality among Spitak earthquake survivors in Armenia. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw171.053] [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: 11/13/2022] Open
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Grigoryan R, Petrosyan V, Melkom Melkomian D, Khachadourian V, McCartor A, Crape B. Risk factors for children's blood lead levels in metal mining and smelting communities in Armenia: a cross-sectional study. BMC Public Health 2016; 16:945. [PMID: 27604802 PMCID: PMC5015252 DOI: 10.1186/s12889-016-3613-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 08/30/2016] [Indexed: 11/11/2022] Open
Abstract
Background Children’s exposure to lead poses a significant risk for neurobehavioral consequences. Existing studies documented lead contamination in residential soil in mining and smelting communities in Armenia. This study aimed to assess blood lead levels (BLL) in children living in three communities in Armenia adjacent to metal mining and smelting industries, and related risk factors. Methods This cross-sectional study included 159 children born from 2007 to 2009 and living in Alaverdi and Akhtala communities and Erebuni district in Yerevan - the capital city. The BLL was measured with a portable LeadCare II Blood Lead Analyzer; a survey was conducted with primary caregivers. Results Overall Geometric Mean (GM) of BLL was 6.0 μg/dl: 6.8 for Akhtala, 6.4 for Alaverdi and 5.1 for Yerevan. In the sample 68.6 % of children had BLL above CDC defined reference level of 5 μg/dl: 83.8 % in Akhtala, 72.5 % in Alaverdi, and 52.8 % in Yerevan. Caregiver’s lower education, dusting furniture less than daily, and housing distance from toxic source(s) were risk factors for higher BLL. Additional analysis for separate communities demonstrated interaction between housing distance from toxic source(s) and type of window in Erebuni district of Yerevan. Conclusions The study demonstrated that children in three communities adjacent to metal mining and smelting industries were exposed to lead. Investigation of the risk factors suggested that in addition to promoting safe industrial practices at the national level, community-specific interventions could be implemented in low- and middle-income countries to reduce BLL among children.
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Affiliation(s)
- Ruzanna Grigoryan
- School of Public Health, American University of Armenia, 40 Marshal Baghramian Avenue, Yerevan, 0019, Armenia
| | - Varduhi Petrosyan
- School of Public Health, American University of Armenia, 40 Marshal Baghramian Avenue, Yerevan, 0019, Armenia
| | - Dzovinar Melkom Melkomian
- School of Public Health, American University of Armenia, 40 Marshal Baghramian Avenue, Yerevan, 0019, Armenia.
| | - Vahe Khachadourian
- Department of Epidemiology, School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Byron Crape
- School of Public Health, American University of Armenia, 40 Marshal Baghramian Avenue, Yerevan, 0019, Armenia
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Khachadourian V, Armenian H, Demirchyan A, Melkonian A, Hovanesian A. A post-earthquake psychopathological investigation in Armenia: methodology, summary of findings, and follow-up. Disasters 2016; 40:518-533. [PMID: 26578424 DOI: 10.1111/disa.12166] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The post-earthquake psychopathological investigation (PEPSI) was designed to probe the short-and long-term effects of the earthquake in northern Armenia on 7 December 1988 on survivors' mental and physical health. Four phases of this study have been conducted to date, and, overall, more than 80 per cent of a sub-sample of 1,773 drawn from an initial cohort of 32,743 was successfully followed during 2012. This paper describes the methodology employed in the evaluation, summarises previous findings, details the current objectives, and examines the general characteristics of the sample based on the most recent follow-up phase outcomes. Despite a significant decrease in psychopathology rates between 1990 and 2012, prevalence rates of post-traumatic stress disorder and depression among study participants in 2012 were greater than 15 and 26 per cent, respectively. The paper also notes the strengths and limitations of the study vis-à-vis future research and highlights the importance and potential practical implications of similar assessments and their outcomes.
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Affiliation(s)
- Vahe Khachadourian
- Research Associate at the College of Health Sciences, American University of Armenia, Armenia
| | - Haroutune Armenian
- Professor at the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, United States
| | - Anahit Demirchyan
- Senior Research Specialist at the College of Health Sciences, American University of Armenia, Armenia
| | | | - Ashot Hovanesian
- Chief Executive Officer at Synergy International Systems, United States
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Truzyan N, Petrosyan V, Harutyunyan A, Khachadourian V, Thompson M. Depressive symptoms among TB patients in Armenia, 2015. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv176.166] [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] Open
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Khachadourian V, Truzyan N, Harutyunyan A, Thompson ME, Harutyunyan T, Petrosyan V. People-centered tuberculosis care versus standard directly observed therapy: study protocol for a cluster randomized controlled trial. Trials 2015; 16:281. [PMID: 26093675 PMCID: PMC4479352 DOI: 10.1186/s13063-015-0802-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 10/15/2014] [Accepted: 06/08/2015] [Indexed: 11/10/2022] Open
Abstract
Background Tuberculosis is a major public health concern resulting in high rates of morbidity and mortality worldwide, particularly in low- and middle-income countries. Tuberculosis requires a long and intensive course of treatment. Thus, various approaches, including patient empowerment, education and counselling sessions, and involvement of family members and community workers, have been suggested for improving treatment adherence and outcome. The current randomized controlled trial aims to evaluate the effectiveness over usual care of an innovative multicomponent people-centered tuberculosis-care strategy in Armenia. Methods/design Innovative Approach to Tuberculosis care in Armenia is an open-label, stratified cluster randomized controlled trial with two parallel arms. Tuberculosis outpatient centers are the clusters assigned to intervention and control arms. Drug-sensitive tuberculosis patients in the continuation phase of treatment in the intervention arm and their family members participate in a short educational and counselling session to raise their knowledge, decrease tuberculosis-related stigma, and enhance treatment adherence. Patients receive the required medications for one week during the weekly visits to the tuberculosis outpatient centers. Additionally, patients receive daily Short Message Service (SMS) reminders to take their medications and daily phone calls to assure adherence and monitoring of treatment potential side effects. Control-arm patients follow the World Health Organization - recommended directly observed treatment strategy, including daily visits to tuberculosis outpatient centers for drug-intake. The primary outcome is physician-reported treatment outcome. Patients’ knowledge, depression, quality of life, within-family tuberculosis-related stigma, family social support, and self-reported adherence to tuberculosis treatment are secondary outcomes. Discussion Improved adherence and tuberculosis treatment outcomes can strengthen tuberculosis control and thereby forestall tuberculosis and multidrug resistant tuberculosis epidemics. Positive findings on effectiveness of this innovative tuberculosis treatment people-centered approach will support its adoption in countries with similar healthcare and economic profiles. Trial registration ClinicalTrials.gov registration number: NCT02082340. Date of registration: 4 March 2014.
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Affiliation(s)
- Vahe Khachadourian
- School of Public Health, American University of Armenia, 40 Marshal Baghramyan Ave, Yerevan, 0019, Armenia.
| | - Nune Truzyan
- School of Public Health, American University of Armenia, 40 Marshal Baghramyan Ave, Yerevan, 0019, Armenia.
| | - Arusyak Harutyunyan
- School of Public Health, American University of Armenia, 40 Marshal Baghramyan Ave, Yerevan, 0019, Armenia.
| | - Michael E Thompson
- Department of Public Health Sciences, College of Health and Human Services, University of North Carolina at Charlotte, 9201 University City Boulevard, CHHS 427D, Charlotte, NC, 28223-0001, USA.
| | - Tsovinar Harutyunyan
- School of Public Health, American University of Armenia, 40 Marshal Baghramyan Ave, Yerevan, 0019, Armenia.
| | - Varduhi Petrosyan
- School of Public Health, American University of Armenia, 40 Marshal Baghramyan Ave, Yerevan, 0019, Armenia.
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Khachadourian V, Armenian HK, Demirchyan A, Goenjian A. Loss and psychosocial factors as determinants of quality of life in a cohort of earthquake survivors. Health Qual Life Outcomes 2015; 13:13. [PMID: 25890107 PMCID: PMC4336679 DOI: 10.1186/s12955-015-0209-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 04/15/2014] [Accepted: 01/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the existing evidence of a long lasting effect of disaster related experiences on physical and psychological health, few studies have evaluated long-term quality of life (QOL) outcomes of disaster survivors and the factors associated with such outcomes. METHODS 23 years after the 1988 Spitak earthquake in Armenia, the associations of demographic characteristics, trauma exposure and psychosocial variables on QOL were explored among a cohort of 725 exposed individuals. The EQ-5D-5 L instrument was applied to measure QOL of participants. Multivariate linear and ordinal logistic regressions were applied to evaluate the determinants of QOL and its underlying five domains (mobility, self-care, usual activity, pain/discomfort, and anxiety/depression). RESULTS Older age, current depression, post-traumatic stress disorder and anxiety symptoms were negatively associated with QOL. Additionally, those with severe losses (who did not receive any financial/material aid) had significantly poorer QOL outcomes, with higher odds of mobility difficulties (OR = 1.86, p < 0.05), self-care difficulties (OR = 2.85, p < 0.05), and mood problems (OR = 2.69, p < 0.05). However, those with severe earthquake related losses who received financial/material aid reported less self-care difficulties (OR = 0.21, p < 0.05) usual activity difficulties (OR = 0.40, p < 0.05), and mood problems (OR = 0.44, p < 0.05). Finally, each unit increase in current social support score was found to be significantly associated with a better QOL outcome and better self-reported outcomes across all underlying domains of QOL. CONCLUSIONS These findings suggest that earthquake related loss and concurrent psychopathology symptoms can have adverse impact on the QOL of survivors. They also indicate that well-targeted post-disaster financial/material aid and social support should be considered as means for improving the long-term QOL outcomes of disaster survivors.
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Affiliation(s)
- Vahe Khachadourian
- School of Public Health, American University of Armenia, Yerevan, Armenia.
| | - Haroutune K Armenian
- Department of Epidemiology, Fielding School of Public Health, UCLA, Los Angeles, CA, USA.
| | - Anahit Demirchyan
- School of Public Health, American University of Armenia, Yerevan, Armenia.
| | - Armen Goenjian
- Department of Psychiatry and Biobehavioral Sciences, UCLA/Duke University National Center for Child Traumatic Stress, UCLA, Los Angeles, CA, USA.
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Demirchyan A, Goenjian AK, Khachadourian V. Factor Structure and Psychometric Properties of the Posttraumatic Stress Disorder (PTSD) Checklist and DSM-5 PTSD Symptom Set in a Long-Term Postearthquake Cohort in Armenia. Assessment 2014. [PMID: 25348800 DOI: 10.1177/1073191114555523.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Psychometric properties of the Armenian-language posttraumatic stress disorder (PTSD) Checklist-Civilian version (PCL-C) and the DSM-5 PTSD symptom set were examined in a long-term cohort of earthquake survivors. In 2012, 725 survivors completed the instruments. Item-/scale-level analysis and confirmatory factor analysis (CFA) were performed for both scales. In addition, exploratory factor analysis (EFA) was conducted for DSM-5 symptoms. Also, the differential internal versus external specificity of PTSD symptom clusters taken from the most supported PTSD structural models was examined. Both scales had Cronbach's alpha greater than .9. CFA of PCL-C structure demonstrated an excellent fit by a four-factor (reexperiencing, avoidance, numbing, and hyperarousal) model known as numbing model; however, a superior fit was achieved by a five-factor model (Elhai et al.). EFA yielded a five-factor structure for DSM-5 symptoms with the aforementioned four domains plus a negative state domain. This model achieved an acceptable fit during CFA, whereas the DSM-5 criteria-based model did not. The Armenian-language PCL-C was recommended as a valid PTSD screening tool. The study findings provided support to the proposed new classification of common mental disorders, where PTSD, depression, and generalized anxiety are grouped together as a subclass of distress disorders. Recommendations were made to further improve the PTSD diagnostic criteria.
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Affiliation(s)
| | - Armen K Goenjian
- UCLA/Duke University National Center for Child Traumatic Stress, University of California, Los Angeles, CA, USA Collaborative Neuroscience Network, Garden Grove, CA, USA
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Demirchyan A, Goenjian AK, Khachadourian V. Factor Structure and Psychometric Properties of the Posttraumatic Stress Disorder (PTSD) Checklist and DSM-5 PTSD Symptom Set in a Long-Term Postearthquake Cohort in Armenia. Assessment 2014; 22:594-606. [PMID: 25348800 DOI: 10.1177/1073191114555523] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [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: 11/16/2022]
Abstract
Psychometric properties of the Armenian-language posttraumatic stress disorder (PTSD) Checklist-Civilian version (PCL-C) and the DSM-5 PTSD symptom set were examined in a long-term cohort of earthquake survivors. In 2012, 725 survivors completed the instruments. Item-/scale-level analysis and confirmatory factor analysis (CFA) were performed for both scales. In addition, exploratory factor analysis (EFA) was conducted for DSM-5 symptoms. Also, the differential internal versus external specificity of PTSD symptom clusters taken from the most supported PTSD structural models was examined. Both scales had Cronbach's alpha greater than .9. CFA of PCL-C structure demonstrated an excellent fit by a four-factor (reexperiencing, avoidance, numbing, and hyperarousal) model known as numbing model; however, a superior fit was achieved by a five-factor model (Elhai et al.). EFA yielded a five-factor structure for DSM-5 symptoms with the aforementioned four domains plus a negative state domain. This model achieved an acceptable fit during CFA, whereas the DSM-5 criteria-based model did not. The Armenian-language PCL-C was recommended as a valid PTSD screening tool. The study findings provided support to the proposed new classification of common mental disorders, where PTSD, depression, and generalized anxiety are grouped together as a subclass of distress disorders. Recommendations were made to further improve the PTSD diagnostic criteria.
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Affiliation(s)
| | - Armen K Goenjian
- UCLA/Duke University National Center for Child Traumatic Stress, University of California, Los Angeles, CA, USA Collaborative Neuroscience Network, Garden Grove, CA, USA
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Khachadourian V, Armenian H, Goenjian A, Demirchyan A, Petrosyan V. Financial/material support and access to care as determinants of recovery from post-earthquake psychopathology: a 23 years longitudinal study. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku164.017] [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: 11/14/2022] Open
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Khachadourian V, Armenian HK, Demirchyan A, Goenjian A. Loss and psycho-social factors as determinants of quality of life among survivors of the 1988 Armenian earthquake: a 23-year follow-up study. Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt126.074] [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: 11/13/2022] Open
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Demirchyan A, Khachadourian V, Armenian HK, Petrosyan V. Short and long term determinants of incident multimorbidity in a cohort of 1988 earthquake survivors in Armenia. Int J Equity Health 2013; 12:68. [PMID: 23962169 PMCID: PMC3751856 DOI: 10.1186/1475-9276-12-68] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [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: 03/19/2013] [Accepted: 05/23/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Multimorbidity, presence of two or more health conditions, is a widespread phenomenon affecting populations' health all over the world. It becomes a serious public health concern due to its negative consequences on quality of life, mortality, and cost of healthcare services utilization. Studies exploring determinants of multimorbidity are limited, particularly those looking at vulnerable populations prospectively over time. This study aimed at identifying short and long term socioeconomic, psychosocial, and health behavioral determinants of incident multimorbidity among a cohort of the 1988 Armenian earthquake survivors. METHODS The study included a representative subsample of 725 from a larger initial cohort of the earthquake survivors. Data on this subsample were collected via four phases of this cohort study during the period 1990-2012. The final logistic regression analysis eliminated all those cases with baseline multimorbidity to investigate short and long term determinants of incident multimorbidity; this subsample included 600 participants. RESULTS More than 75% of the studied sample had multimorbidity. Perceived low affordability of healthcare services, poor living standards during the post-earthquake decade, and lower education were independent predictors of incident multimorbidity developed during the period 1990-2012. Stressful life events and poor social support were among psychosocial determinants of incident multimorbidity. Participants' baseline BMI reported in 1990 was independently associated with incident multimorbidity. CONCLUSIONS Most of the identified determinants of incident multimorbidity in our study population were markers of social inequities, indicating that inequities pose a serious threat to both individual and public health-related outcomes. Strategies targeting to decrease such inequities along with promotion of healthy lifestyle and strengthening of social networks may considerably reduce multimorbidity among population groups with similar socioeconomic and cultural profiles.
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Affiliation(s)
- Anahit Demirchyan
- School of Public Health, American University of Armenia, 40 Marshal Baghramian Avenue, Yerevan 0019, Armenia.
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