Oluwatoyosi A. Adekeye

Cervical Cancer and Pap Smear Awareness and Utilization of Pap Smear Test among Federal Civil Servants in North Central Nigeria

Cervical cancer is a leading cause of cancer death in women in developing countries. A key factor linked to the relatively high levels of cervical cancer in these populations is the lack of awareness and access to preventive methods. This study aimed to determine the level of awareness of cervical cancer and Papanicolaou test (Pap smear test) and factors associated with the utilization of Pap test among female civil servants in Jos. Data was obtained from female workers (n = 388) aged 18–65 years in a Nigerian Federal establishment. Participants were randomly approached and instructed to complete validated questionnaires. Data was analyzed using Chi-square, t-tests and logistic regression analysis to determine if there was an association between variables and identify any predictors of awareness and utilization of the Pap test. Cervical cancer and Pap smear test awareness was 50.9% and 38.6% respectively, with the media as the major source of information. Pap smear test utilization rate was 10.2%, with routine antenatal care (ANC) as the major reason for getting screened. Personal barriers to screening include the lack of awareness, and belief that cervical cancer is not preventable. Opportunistic screening, mass media campaigns and ANC education were suggested as ways of improving awareness and utilization of cervical cancer screening services.

The New Invincibles: HIV Screening among Older Adults in the U.S

Background Thirteen percent of the U.S. population is ages 65 and older, a number projected to reach 20% by 2030. By 2015, 50% of Human Immunodeficiency Virus (HIV)-infected individuals in the U.S. are expected to be ages 50 and older. Current Centers for Disease Control and Prevention guidelines recommend “opt-out” HIV screening for individuals ages 13–64. The purpose of this study was to assess the occurrence and barriers to HIV screening in older adults, and to evaluate the rationale for expanding routine HIV screening to this population. Methods The study used 2009 National Health Interview Survey (NHIS) data. A total of 12,366 (unweighted) adults, ages 50 and older, participated in the adult section of the NHIS and answered questions on the HIV/AIDS, Sexually Transmitted Diseases, and Tuberculosis components. Associations between HIV screening, socio-demographic variables, and knowledge of HIV-related disease were examined using logistic regression models. Results The HIV screening rate within this population was 25.4%. Race had no statistically significant effect. Low risk perception of HIV exposure (84.1%) accounted for low likelihood of planned screening (3.5%) within 12 months post survey. A routine medical check-up was the single most common reason for HIV screening (37.6%), with only about half (52.7%) of the tests suggested by a health care provider. Conclusion It is imperative that practices and policies are developed and implemented to increase HIV awareness and screening in the older adult population. Increased health care provider awareness of the importance of HIV screening, especially for those 65 and older, is critical. Health policies and clinical guidelines should be revised to promote and support screening of all adults.

Malnutrition in Sickle Cell Anemia: Implications for Infection, Growth, and Maturation

Sickle cell anemia (SCA) is a genetic disease that affects mostly individuals of African and/or Hispanic descent, with the majority of cases in sub-Saharan Africa. Individuals with this disease show slowed growth, delayed sexual maturity, and poor immunologic function. These complications could partly be explained by the state of undernutrition associated with the disease. Proposed mechanism of undernutrition include protein hypermetabolism, decreased dietary intake possibly from interleukin-6-related appetite suppression, increased cardiac energy demand/expenditure, and increased red cell turnover. All the above mechanisms manifest as increased resting energy expenditure. Nutritional intervention utilizing single or multiple nutrient supplementation has led to improved clinical outcome, growth, and sexual maturation. Studies are currently underway to determine the best possible approach to applying nutritional intervention in the management of SCA. Management of SCA will, of necessity, involve a nutritional component, given the sociodemographic distribution of those most affected by the disease, the ease of a nutritional approach, and the wider reach that such an approach will embody.

Adherence to combination antiretroviral treatment and clinical outcomes in a Medicaid sample of older HIV-infected adults

ABSTRACT The adherence threshold for combination antiretroviral therapy (cART) has historically been set at 95% or greater. We examined whether different levels of cART adherence (≥95% [optimal adherence], 90–94%, 80–89%, and <80%) were associated with different clinical outcomes (emergency department visits [ED visits] and duration of hospital admission) in a sample of older (50–64 years) persons living with HIV (PLWH). Medicaid data from 29 US states (n = 5177) were used for this study. cART adherence was measured and data regarding relevant covariates, such as race, sex, age, urbanicity, and comorbidity were obtained. Descriptive statistics were conducted to characterize study participants. We conducted univariate and multivariable regression analyses to evaluate the association between cART adherence and ED visits and duration of hospital admission while adjusting for covariates (race, sex, age, urbanicity, and comorbidity). Approximately 32% of all participants (n = 5177) reported optimal cART adherence (≥95%). After adjusting for covariates, only participants who reported <80% adherence were more likely to have an ED visit (adjusted odds ratio = 1.34, 95% CI = 1.08–1.48, p < .0001) and a longer duration of hospital admission (regression coefficient = 1.24, 95% CI = 0.53–1.96, p = .0007) when compared to participants who reported ≥95% adherence. There were no significant differences in likelihood of having an ED visit and longer duration of hospital admission between participants who reported ≥95% adherence and participants who reported 90–94% adherence and 80–89% adherence. Significant differences by covariates were observed. Adverse clinical outcomes were associated with low cART adherence (<80%) among older PLWH, though they did not differ between optimal and moderate cART adherence (90–94% and 80–89%). Although optimal cART adherence is an important goal, clinical outcomes in older PLWH may not differ between moderate and optimal cART adherence.

Health Literacy from the Perspective of African Immigrant Youth and Elderly: A PhotoVoice Project

Background. This project examines the views of African immigrants on health, access to health resources in the U.S., and perceived barriers to a healthy wellbeing faced by the elderly immigrants in the community. Methods. PhotoVoice methodology was used to evaluate the views of African immigrant youths and elderly drawn from a convenience sample. Participants were trained on the use of cameras and guided by research questions while taking photographs. The photographs were analyzed, coded into themes and presented to community resource representatives at a photo exhibit. Results. Emergent themes were: 1) nutrition, obesity and physical activity; 2) occupational regulation and educational opportunities; 3) feeling of security and public safety; 4) ethno-racial diversity and the health care system; 5) religiosity and social well-being. Discussion. These results have implications for health care professionals and community agencies serving immigrant populations. A deeper look into the health issues affecting this population is essential.

The Effect of Educational Attainment on HIV Testing Among African Americans

A person is infected with human immunodeficiency virus (HIV) every nine and half minutes in the United States., Moreover, one in five people infected with HIV in the United States does not know their status. While African Americans make up just 14% of the United States population, they constitute 44% of new HIV infections each year in the United States.4 This study examined the relationship between level of education and HIV testing among African Americans. A sample of 3,254 African American men and women between 18–84 years of age was isolated from the 2008 National Health Interview Survey and analyzed. The results revealed that African Americans with greater educational attainment (high school diploma or greater) are more likely to report having been tested for HIV than those who have not graduated from high school.

HIV Screening Rates among Medicaid Enrollees Diagnosed with Other Sexually Transmitted Infections

Introduction Approximately 20 million new sexually transmitted infections (STIs) are diagnosed yearly in the United States costing the healthcare system an estimated

Barriers to Healthcare among African Immigrants in Georgia, USA

16 billion in direct medical expenses. The presence of other STIs increases the risk of HIV transmission. The Centers for Disease Control and Prevention (CDC) has long recommended routine HIV screening for individuals with a diagnosed STI. Unfortunately, HIV screening prevalence among STI diagnosed patients are still sub-optimal in many healthcare settings. Objective To determine the proportion of STI-diagnosed persons in the Medicaid population who are screened for HIV, examine correlates of HIV screening, and to suggest critical intervention points to increase HIV screening in this population. Methods A retrospective database analysis was conducted to examine the prevalence and correlates of HIV screening among participants. Participant eligibility was restricted to Medicaid enrollees in 29 states with a primary STI diagnosis (chlamydia, gonorrhea, and syphilis) or pelvic inflammatory disease claim in 2009. HIV-positive persons were excluded from the study. Frequencies and descriptive statistics were conducted to characterize the sample in general and by STI diagnosis. Univariate and multivariate logistic regression were performed to estimate unadjusted odds ratios and adjusted odds ratio respectively and the 95% confidence intervals. Multivariate logistic regression models that included the independent variables (race, STI diagnosis, and healthcare setting) and covariates (gender, residential status, age, and state) were analyzed to examine independent associations with HIV screening. Results About 43% of all STI-diagnosed study participants were screened for HIV. STI-diagnosed persons that were between 20–24 years, female, residing in a large metropolitan area and with a syphilis diagnosis were more likely to be screened for HIV. Participants who received their STI diagnosis in the emergency department were less likely to be screened for HIV than those diagnosed in a physician’s office. Conclusion This study showed that HIV screening prevalence among persons diagnosed with an STI are lower than expected based on the CDC’s recommendations. These suboptimal HIV screening prevalence present “missed opportunities” for HIV screening in at-risk populations. Measures and incentives to increase HIV screening among all STI-diagnosed persons are vital to the timely identification of HIV infection, linkage to HIV care, and mitigating further HIV transmission.

Exploring the Link Between Substance Use and Mental Health Status: What Can We Learn from the Self-medication Theory?

African-born immigrants are among the fastest growing immigrant groups in the US, yet they are underrepresented in healthcare research, particularly, cancer research and tend to be categorized as African American or Black, obscuring any cultural nuances that exist. A survey designed to provide insight on the barriers to healthcare, knowledge of common cancers, and cancer risks was utilized during a health fair. Data analyses included descriptive statistics to examine participant demographics and other study variables of interest. Most of the participants reported African origin (approximately 97%), were males (59%), were aged 18–40 years (49%), had a minimum of some college education (78%), a household income of >

Effect of Digoxin Use Among Medicaid Enrollees With Atrial Fibrillation

50,000 (35%) and were mostly uninsured (45%). The cost of medical treatment 19 (45.2%) was reported as a major barrier to healthcare access. The Health Fair presented the opportunity to provide free health screenings, education/awareness, and referral to follow-up resources. The findings are evidence of the importance and impact of health fairs in communities of greatest need.