Predictors Of Prenatal Care Satisfaction Among Pregnant Women In American Samoa

Objectives: Women of reproductive age in American Samoa have a high-risk for pregnancy complications, due to their high levels of overweight and obesity. Prenatal care can mitigate this risk; however, many women do not seek care. The low rate of prenatal care utilization may stem from a low-level of prenatal care satisfaction. By understanding the predictors of prenatal care satisfaction in America Samoa, targets for improvement may be identified, with the ultimate goal of increasing prenatal care utilization. Methods: A cross-sectional survey was distributed to women (n=174) in the waiting areas of the clinic at the Lyndon B Johnson Tropical Medical Center, Pago Pago. Women were asked about their demographic background, pregnancy traits, and their satisfaction with prenatal care. Complete satisfaction data was obtained for 165 participants. Different components of satisfaction were extracted using principal components analysis. Linear regression was used to examine associations between maternal characteristics and satisfaction score within these individual components and overall. Results: The satisfaction questionnaire yielded three components: satisfaction with Clinic Services, Accessibility, and Physician Interactions. Waiting two hours or more to see the doctor was a significant predictor of less satisfaction with Clinic Services, Accessibility, and Overall satisfaction compared to waiting less than 30 minutes. Living more than 20 minutes away from the clinic was associated with less satisfaction with Accessibility, Physician Interactions, and Overall, whereas non-residence was associated with greater satisfaction with Accessibility. Women who were employed or on maternity leave were less satisfied with Physician Interactions than women who were unemployed or students. Of women who had previously been pregnant, a previous pregnancy loss was associated with less satisfaction with Physician Interactions compared to women who had not experienced a pregnancy loss. Women who did not attend all of their appointments were less satisfied with their care overall compared to women who did. Conclusions for Practice: Prenatal care satisfaction is an important determinant of prenatal care utilization. By identifying specific characteristics that predicted lower satisfaction, we are able to guide providers and health services towards improved prenatal care delivery. Prenatal care clinics should focus on making it easier for women to get to the clinics, decreasing waiting times, and increasing quality face time with providers

Prevalence of chronic pulmonary aspergillosis in two Tuberculosis treatment clinics in Lagos, Nigeria: a prospective longitudinal study

International audienceAbstract Background Chronic pulmonary aspergillosis (CPA) is an underrecognized but common complication of pulmonary tuberculosis (TB). In Nigeria, a TB-endemic country, there is currently no provision to monitor the development of CPA in patients treated for TB. This study determined the prevalence and incidence of CPA in Lagos, Nigeria. Methods A prospective longitudinal study of patients previously managed for TB was conducted between June 2021 and May 2022. The study cohorts were assessed at three monthly intervals with the following parameters collected: sociodemographic data, chest x-ray findings, sputum for fungal culture, and venous blood for Aspergillus IgG estimation. CPA cases were determined using the case definition for resource-constrained countries. Descriptive and inferential statistics were employed and significance was set at a probability of 5% (p<0.05). Results Of 141 patients recruited, 79 (56.0%) belonged to retreatment TB and 62 (44.0%) were post-TB treated patients. The median (interquartile range) age was 40 (30-52) years, with a male-to-female ratio of 1.1:1. Ninety-seven patients (69%) had a GeneXpert test done, of which, 63/97 (64.9%) were GeneXpert negative. Cough was the commonest symptom, with 15 (11%) having haemoptysis. The rate of CPA increased steadily as the study progressed: 44 (31.2%) at commencement, 45 (34.9%) at three months, 49 (42.6%) at six months, and 51 (54.3%) at nine months. Thus, the overall prevalence of CPA was 49.7% and the incidence was 6.1%. Conclusion CPA is common in Nigeria and its true burden may still be underestimated. Increased awareness of CPA as a post-TB lung disease is advocated. Evaluation for CPA should be incorporated in patients’ work-up for T

LGBQ-Affirmative Cognitive-Behavioral Therapy for Young Gay and Bisexual Men's Mental and Sexual Health: A Three-Arm Randomized Controlled Trial

Objective: Effective Skills to Empower Effective Men (ESTEEM) represents the first intervention to address the psychological pathways through which minority stress undermines young sexual minority men's (SMM's) mental and sexual health using transdiagnostic cognitive-behavioral therapy. This study compared the efficacy of ESTEEM against two existing interventions. Method: Participants were young human immunodeficiency virus (HIV)-negative SMM (N = 254; ages = 18-35; 67.2% racial/ethnic minority) experiencing a depression, anxiety, and/or stress-/trauma-related disorder and past-90-day HIV transmission risk behavior. After completing HIV testing and counseling, participants were randomized to receive 10-session ESTEEM (n = 100); 10-session community-based lesbian, gay, bisexual, and queer/questioning (LGBQ)-affirmative counseling (n = 102); or only HIV testing and counseling (n = 52). Results: For the primary outcome of any HIV transmission risk behavior at 8 months, ESTEEM was not significantly associated with greater reduction compared to HIV testing and counseling (risk ratio [RR] = 0.89, p = .52). Supportive analyses of the frequency of HIV transmission risk behavior at 8 months showed a nonsignificant difference between ESTEEM compared to HIV testing and counseling (RR = 0.69) and LGBQ-affirmative counseling (RR = 0.62). For secondary outcomes (e.g., depression, anxiety, substance use, suicidality, number of mental health diagnoses) at 8 months, ESTEEM had a larger effect size than the two comparison conditions, but these comparisons did not reach statistical significance when adjusting for the false discovery rate. Observed effect sizes for condition comparisons were smaller than the effect sizes used to power the study. In exploratory analyses, ESTEEM showed promise for reducing comorbidity. Conclusions: Because the control conditions were associated with stronger effects than anticipated, and given the heterogeneous nature of transdiagnostic outcomes, the study possessed insufficient power to statistically detect the consistently small-to-moderate benefit of ESTEEM compared to the two control conditions. What is the public health significance of this article? As long as young sexual minority men (SMM) face minority stress, identity-affirming and effective psychological interventions are needed to address the impact that this stress has on their mental and sexual health. This study found evidence that an lesbian, gay, bisexual, and queer/questioning (LGBQ)-affirmative, minority-stress-focused, transdiagnostic cognitive-behavioral therapy (CBT) intervention called ESTEEM was associated with reductions across numerous mental and sexual health outcomes among young SMM experiencing co-occurring mental and sexual health concerns, though not significantly greater reductions than the two existing interventions to which ESTEEM was compared

Project ESTEEM protocol: a randomized controlled trial of an LGBTQ-affirmative treatment for young adult sexual minority men’s mental and sexual health

Background Young gay and bisexual men disproportionately experience depression, anxiety, and substance use problems and are among the highest risk group for HIV infection in the U.S. Diverse methods locate the source of these health disparities in young gay and bisexual men’s exposure to minority stress. In fact, minority stress, psychiatric morbidity, substance use, and HIV risk fuel each other, forming a synergistic threat to young gay and bisexual men’s health. Yet no known intervention addresses minority stress to improve mental health, substance use problems, or their joint impact on HIV risk in this population. This paper describes the design of a study to test the efficacy of such an intervention, called ESTEEM (Effective Skills to Empower Effective Men), a 10-session skills-building intervention designed to reduce young gay and bisexual men’s co-occurring health risks by addressing the underlying cognitive, affective, and behavioral pathways through which minority stress impairs health. Methods This study, funded by the National Institute of Mental Health, is a three-arm randomized controlled trial to examine (1) the efficacy of ESTEEM compared to community mental health treatment and HIV counseling and testing and (2) whether ESTEEM works through its hypothesized cognitive, affective, and behavioral minority stress processes. Our primary outcome, measured 8 months after baseline, is condomless anal sex in the absence of PrEP or known undetectable viral load of HIV+ primary partners. Secondary outcomes include depression, anxiety, substance use, sexual compulsivity, and PrEP uptake, also measured 8 months after baseline. Discussion Delivering specific stand-alone treatments for specific mental, behavioral, and sexual health problems represents the current state of evidence-based practice. However, dissemination and implementation of this one treatment-one problem approach has not been ideal. A single intervention that reduces young gay and bisexual men’s depression, anxiety, substance use, and HIV risk by reducing the common minority stress pathways across these problems would represent an efficient, cost-effective alternative to currently isolated approaches, and holds great promise for reducing sexual orientation health disparities among young men. Trial registration Registered October 10, 2016 to ClinicalTrials.gov Identifier: NCT02929069