Arin Balalian | Texas A&M University (original) (raw)
Papers by Arin Balalian
Current developments in nutrition, Jul 1, 2024
Science of the total environment, Apr 1, 2024
Purpose Healthcare workers (HCWs) were at increased risk for mental health problems during the CO... more Purpose Healthcare workers (HCWs) were at increased risk for mental health problems during the COVID-19 pandemic, with data from previous crises suggesting women may be particularly vulnerable. The objective of the study was to examine individual and social factors that may be associated with gender differences in psychological distress and depressive symptoms among HCWs during the initial COVID-19 pandemic outbreak and to examine the consistency of these differences across a diverse range of countries. Methods Data were collected in a cross-sectional design between March 2020 and February 2021 as part of the COVID-19 HEalth caRe wOrkErS (HEROES) study. 32,410 HCWs recruited across 22 countries completed the General Health Questionnaire-12 (GHQ-12), the Patient Health Questionnaire-9 (PHQ-9), and questions about pandemic-relevant exposures. Results Consistently across countries, women reported elevated mental health problems compared to men. Women also reported increased COVID-19-re...
Environmental research, Apr 1, 2024
Environmental health perspectives, Oct 26, 2020
Environmental epidemiology, Oct 1, 2019
PLOS global public health, May 5, 2023
With the fourth highest breast cancer mortality rate in the world, breast cancer prevention and e... more With the fourth highest breast cancer mortality rate in the world, breast cancer prevention and early detection is a priority for Armenia. The Ministry of Health recently initiated efforts to expand access to breast cancer screening. However, little is known about the population's understanding and perception of breast cancer screening programs. This cross-sectional telephone-based study sought to develop and validate an Eastern Armenian language version of the Champion's Health Belief Model Scale (CHBMS) for future use. The English-language CHBMS survey was first rigorously translated by two Armenian nationals and evaluated for face validity. Telephone surveys were then administered to randomlyselected women of approximately screening age (35-65 years) with no prior history of breast cancer living in Armenia's capital between 2019-2020 (n = 103). The translated survey's psychometric properties were evaluated, examining (1) content equivalence, (2) testretest reliability and (3) internal consistency. Content equivalence and test-retest reliability of the Armenian CHBMS were characterized using correlational analysis with Pearson's coefficient ranging from 0.76-0.97 (p<0.001) and 0.72-0.97 (p<0.001), respectively, for all five CHBMS domains. The translated survey's internal consistency was comparable to the original English-language CHBMS with a Cronbach's alpha greater than 0.7 for all five domains (0.75-0.94 (p<0.001). The translated Eastern Armenian version of CHBMS is a valid, internally-consistent, and reliable research tool that is ready for imminent use among screening-age women to investigate breast cancer perceptions and beliefs as the Armenian government seeks to expand screening access.
American Journal of Epidemiology, Apr 21, 2023
Studies suggest a link between particulate matter less than or equal to 2.5 μm in diameter (PM2.5... more Studies suggest a link between particulate matter less than or equal to 2.5 μm in diameter (PM2.5) and amyotrophic lateral sclerosis (ALS), but to our knowledge critical exposure windows have not been examined. We performed a case-control study in the Danish population spanning the years 1989–2013. Cases were selected from the Danish National Patient Registry based on International Classification of Diseases codes. Five controls were randomly selected from the Danish Civil Registry and matched to a case on vital status, age, and sex. PM2.5 concentration at residential addresses was assigned using monthly predictions from a dispersion model. We used conditional logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for confounding. We evaluated exposure to averaged PM2.5 concentrations 12–24 months, 2–6 years, and 2–11 years pre–ALS diagnosis; annual lagged exposures up to 11 years prediagnosis; and cumulative associations for exposure in lags 1–5 years and 1–10 years prediagnosis, allowing for varying association estimates by year. We identified 3,983 cases and 19,915 controls. Cumulative exposure to PM2.5 in the period 2–6 years prediagnosis was associated with ALS (OR = 1.06, 95% CI: 0.99, 1.13). Exposures in the second, third, and fourth years prediagnosis were individually associated with higher odds of ALS (e.g., for lag 1, OR = 1.04, 95% CI: 1.00, 1.08). Exposure to PM2.5 within 6 years before diagnosis may represent a critical exposure window for ALS.
Frontiers in Pediatrics
AimThis systematic review aims to estimate the relationship between prenatal exposure to opioids ... more AimThis systematic review aims to estimate the relationship between prenatal exposure to opioids and neurodevelopmental outcomes and examines potential sources of heterogeneity between the studies.MethodsWe searched four databases through May 21st, 2022: PubMed, Embase, PsycInfo and the Web of Science according to a specified search strings. Study inclusion criteria include: (1) cohort and case-control peer-reviewed studies published in English; (2) studies comparing neurodevelopmental outcomes among children with prenatal opioid-exposure (prescribed or used non-medically) vs. an unexposed group. Studies investigating fetal alcohol syndrome or a different primary prenatal exposure other than opioids were excluded. Two main performed data extraction using “Covidence” systematic review platform. This systematic review was conducted in accordance with PRISMA guidelines. The Newcastle-Ottawa-Scale was used for quality assessment of the studies. Studies were synthesized based on the type...
International Journal of Hygiene and Environmental Health
Environmental Epidemiology, 2019
Introduction: Phthalates are a group of high production chemicals, generally used as plasticizers... more Introduction: Phthalates are a group of high production chemicals, generally used as plasticizers and odor enhancers. Phthalates cross the blood-placenta barrier and are associated with deficits in cognitive functions and behavior problems in offspring. We previously reported sex-specific associations with motor function when phthalates are considered singly. Because exposure to phthalates usually occurs as mixtures, here we assess these associations between a mixture of phthalates and motor function at age 11 years. Methods: Data come from the prospective cohort study of mothers and offspring who participated in the Columbia Center for Children's Environmental Health birth cohort (CCCEH). Seven phthalate metabolites were measured in maternal spot urine obtained during the third trimester and motor function was evaluated using the short form of the Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition (BOT-2) at the age of 11 years. We used Weighted Quartile Sum (WQS) regression models to examine the effect of phthalate metabolites in males and females separately. The models were adjusted for child age in months, child BMI, maternal race (African-American vs. Dominican), prenatal alcohol consumption, maternal demoralization score, HOME score, and urine specific gravity. In a secondary analysis we used linear regression models to examine the association between the sum of molar concentrations of both DEHP and non-DEHP metabolites, and outcomes of gross and fine motor functions. Results: 209 mother-child pairs were eligible for this analysis. A significant decrease in fine-motor functions was observed among females, but not among males, following exposure to high levels of weighted quartile sum of seven phthalate metabolites (Covariates-adjusted coefficient estimate B = −2.7, 95% Confidence Interval [CI] −4.64 to −0.75, p = 0.01 for females [n = 116] and B = −1.63, 95%CI −3.94 to 0.69, p = 0.16 for males [n = 93]). The most highly weighted phthalate metabolites, associated with fine-motor functions among females, were MBP, MBZP, and MIBP, all non-DEHP phthalates. No significant associations were found between the weighted quartile sum of seven phthalate metabolites and gross-motor functions at the age of 11 years for males (B = −0.81, 95%CI −1.17 to 1.96, p = 0.23). With the molar sum of four non-DEHP phthalates as main predictor of linear regression models, we found significant decrease in gross and fine motor functions among females prenatally exposed to non-DEHP phthalates B = −0.98, 95%CI −1.98 to 0.03, p = 0.05 and B = −0.85, 95%CI −1.49 to −0.20, p = 0.01, respectively). Conclusions: Phthalate exposure during pregnancy was associated with decreased motor functions among 11year-old girls.
BMC Nutrition, 2017
Background: Despite global efforts, stunting remains a public health problem in several developin... more Background: Despite global efforts, stunting remains a public health problem in several developing countries. The prevalence of stunting among 0-to 5-year-old children in Armenia has increased from 17% in 2000 to 19% in 2010. A baseline study was conducted among preschool children in Berd, a region near the northeastern border of Armenia that has experienced intermittent military tension for over 20 years. Methods: We conducted a cross-sectional study including 594 children aged 6-month-6 years old and their caregivers in our analysis, to assess the prevalence and determinants of stunting. We calculated the anthropometric measurements and hemoglobin levels of children; analyzed children's stool and conducted a survey with children's caregivers. We employed the hierarchical logistic regression model to explore the predictors of stunting among 25-72 months old children and multivariable logistic regression models to investigate the predictors of stunting among 6-24 months old children. Individual and residence level variables were included in the models including anemia, minimum dietary diversity, mothers' height, the overall duration of breastfeeding, birthweight, child's history of diarrhea and mean socioeconomic score. Results: The prevalence of stunting was significantly higher among the 6-24 months old children (13.3%) compared to the children aged 25-72 months old (7.8%). We did not find any differences in the prevalence of stunting by place of residence in either age group. The 6-24 months old children who consumed at least four food groups during the previous day (minimum dietary diversity) had 72% lower odds of being stunted (p < 0.05). Each kilogram increase in birthweight was associated with 76% lower odds of being stunted (OR = 0.24, p < 0.01). Mother's height significantly decreased the odds of stunting among the children 25-72-months old (OR = 0.86, p < 0.001). BMI was also a significant predictor of stunting among both age-groups. Conclusions: The study results highlight the significance of mother's height, birthweight, and adequate complementary feeding to reduce stunting. Further studies are needed to determine the possible association of anemia and stunting with the ongoing conflict in the region, as well as socioeconomic conditions and food insecurity in the region.
European Journal of Public Health, 2016
European Journal of Public Health, 2020
Background The nonmedical use of opioids during pregnancy, either those prescribed or obtained il... more Background The nonmedical use of opioids during pregnancy, either those prescribed or obtained illegally, is a worldwide public health issue. Opioids pass through the placental barrier, which can expose the fetus to maternal opioid use; opioid-exposed babies may experience Neonatal Abstinence Syndrome (or Neonatal Opioid Withdrawal). We conducted a systematic review and meta-analysis to investigate how maternal opioid use during pregnancy may impact infants' birth outcomes. Methods We searched PubMed, Embase, PsycInfo, and the Web of Science, and identified 90 articles that met our inclusion criteria. Cohort, case-control and cross-sectional studies comparing birth outcomes of any opioid-exposed group (prescribed or obtained illegally) and a non-exposed comparison group were eligible for our systematic review. An adapted version of the Newcastle-Ottawa-Scale was used for quality assessment of the studies. Due to high heterogeneity between studies, we used random effects models t...
Public Health Nutrition, 2019
Objective: We investigated short- and long-term indicators of malnutrition and diet before and af... more Objective: We investigated short- and long-term indicators of malnutrition and diet before and after the community-based ‘Breaking the Cycle of Poverty’ multidisciplinary intervention. Design: A historically and geographically controlled study using data collected in 2013 and 2016. We compared the prevalence of short-term indicators (anaemia, breast-feeding duration and minimum dietary diversity) and long-term indicators (stunting and wasting) in exposed communities at two time points. We then compared these factors in geographic areas exposed or not exposed to intervention. We conducted logistic regression analyses on the 2016 sample to measure associations between living in intervention communities and child growth indicators. Setting: Berd region, a chronic conflict zone near the north-eastern border of Armenia and Azerbaijan. Participants: Children aged 6 months to 6 years. Results: Analyses included data from 2013 comprising 382 children, and data from 2016 comprising 348 child...
Social Psychiatry and Psychiatric Epidemiology
Background Preliminary country-specific reports suggest that the COVID-19 pandemic has a negative... more Background Preliminary country-specific reports suggest that the COVID-19 pandemic has a negative impact on the mental health of the healthcare workforce. In this paper, we summarize the protocol of the COVID-19 HEalth caRe wOrkErS (HEROES) study, an ongoing, global initiative, aimed to describe and track longitudinal trajectories of mental health symptoms and disorders among health care workers at different phases of the pandemic across a wide range of countries in Latin America, Europe, Africa, Middle-East, and Asia. Methods Participants from various settings, including primary care clinics, hospitals, nursing homes, and mental health facilities, are being enrolled. In 26 countries, we are using a similar study design with harmonized measures to capture data on COVID-19 related exposures and variables of interest during two years of follow-up. Exposures include potential stressors related to working in healthcare during the COVID-19 pandemic, as well as sociodemographic and clinical factors. Primary outcomes of interest include mental health variables such as psychological distress, depressive symptoms, and posttraumatic stress disorders. Other domains of interest include potentially mediating or moderating influences such as workplace conditions, trust in the government, and the country's income level. Results As of August 2021, ~ 34,000 health workers have been recruited. A general characterization of the recruited samples by sociodemographic and workplace variables is presented. Most participating countries have identified several health facilities where they can identify denominators and attain acceptable response rates. Of the 26 countries, 22 are collecting data and 2 plan to start shortly. Conclusions This is one of the most extensive global studies on the mental health of healthcare workers during the COVID-19 pandemic, including a variety of countries with diverse economic realities and different levels of severity of pandemic and management. Moreover, unlike most previous studies, we included workers (clinical and non-clinical staff) in a wide range of settings.
Adapting continuing medical education for postconflict areas: assessment in Nagorno Karabagh- a q... more Adapting continuing medical education for postconflict areas: assessment in Nagorno Karabagh- a qualitative study
ISEE Conference Abstracts, 2021
Current developments in nutrition, Jul 1, 2024
Science of the total environment, Apr 1, 2024
Purpose Healthcare workers (HCWs) were at increased risk for mental health problems during the CO... more Purpose Healthcare workers (HCWs) were at increased risk for mental health problems during the COVID-19 pandemic, with data from previous crises suggesting women may be particularly vulnerable. The objective of the study was to examine individual and social factors that may be associated with gender differences in psychological distress and depressive symptoms among HCWs during the initial COVID-19 pandemic outbreak and to examine the consistency of these differences across a diverse range of countries. Methods Data were collected in a cross-sectional design between March 2020 and February 2021 as part of the COVID-19 HEalth caRe wOrkErS (HEROES) study. 32,410 HCWs recruited across 22 countries completed the General Health Questionnaire-12 (GHQ-12), the Patient Health Questionnaire-9 (PHQ-9), and questions about pandemic-relevant exposures. Results Consistently across countries, women reported elevated mental health problems compared to men. Women also reported increased COVID-19-re...
Environmental research, Apr 1, 2024
Environmental health perspectives, Oct 26, 2020
Environmental epidemiology, Oct 1, 2019
PLOS global public health, May 5, 2023
With the fourth highest breast cancer mortality rate in the world, breast cancer prevention and e... more With the fourth highest breast cancer mortality rate in the world, breast cancer prevention and early detection is a priority for Armenia. The Ministry of Health recently initiated efforts to expand access to breast cancer screening. However, little is known about the population's understanding and perception of breast cancer screening programs. This cross-sectional telephone-based study sought to develop and validate an Eastern Armenian language version of the Champion's Health Belief Model Scale (CHBMS) for future use. The English-language CHBMS survey was first rigorously translated by two Armenian nationals and evaluated for face validity. Telephone surveys were then administered to randomlyselected women of approximately screening age (35-65 years) with no prior history of breast cancer living in Armenia's capital between 2019-2020 (n = 103). The translated survey's psychometric properties were evaluated, examining (1) content equivalence, (2) testretest reliability and (3) internal consistency. Content equivalence and test-retest reliability of the Armenian CHBMS were characterized using correlational analysis with Pearson's coefficient ranging from 0.76-0.97 (p<0.001) and 0.72-0.97 (p<0.001), respectively, for all five CHBMS domains. The translated survey's internal consistency was comparable to the original English-language CHBMS with a Cronbach's alpha greater than 0.7 for all five domains (0.75-0.94 (p<0.001). The translated Eastern Armenian version of CHBMS is a valid, internally-consistent, and reliable research tool that is ready for imminent use among screening-age women to investigate breast cancer perceptions and beliefs as the Armenian government seeks to expand screening access.
American Journal of Epidemiology, Apr 21, 2023
Studies suggest a link between particulate matter less than or equal to 2.5 μm in diameter (PM2.5... more Studies suggest a link between particulate matter less than or equal to 2.5 μm in diameter (PM2.5) and amyotrophic lateral sclerosis (ALS), but to our knowledge critical exposure windows have not been examined. We performed a case-control study in the Danish population spanning the years 1989–2013. Cases were selected from the Danish National Patient Registry based on International Classification of Diseases codes. Five controls were randomly selected from the Danish Civil Registry and matched to a case on vital status, age, and sex. PM2.5 concentration at residential addresses was assigned using monthly predictions from a dispersion model. We used conditional logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for confounding. We evaluated exposure to averaged PM2.5 concentrations 12–24 months, 2–6 years, and 2–11 years pre–ALS diagnosis; annual lagged exposures up to 11 years prediagnosis; and cumulative associations for exposure in lags 1–5 years and 1–10 years prediagnosis, allowing for varying association estimates by year. We identified 3,983 cases and 19,915 controls. Cumulative exposure to PM2.5 in the period 2–6 years prediagnosis was associated with ALS (OR = 1.06, 95% CI: 0.99, 1.13). Exposures in the second, third, and fourth years prediagnosis were individually associated with higher odds of ALS (e.g., for lag 1, OR = 1.04, 95% CI: 1.00, 1.08). Exposure to PM2.5 within 6 years before diagnosis may represent a critical exposure window for ALS.
Frontiers in Pediatrics
AimThis systematic review aims to estimate the relationship between prenatal exposure to opioids ... more AimThis systematic review aims to estimate the relationship between prenatal exposure to opioids and neurodevelopmental outcomes and examines potential sources of heterogeneity between the studies.MethodsWe searched four databases through May 21st, 2022: PubMed, Embase, PsycInfo and the Web of Science according to a specified search strings. Study inclusion criteria include: (1) cohort and case-control peer-reviewed studies published in English; (2) studies comparing neurodevelopmental outcomes among children with prenatal opioid-exposure (prescribed or used non-medically) vs. an unexposed group. Studies investigating fetal alcohol syndrome or a different primary prenatal exposure other than opioids were excluded. Two main performed data extraction using “Covidence” systematic review platform. This systematic review was conducted in accordance with PRISMA guidelines. The Newcastle-Ottawa-Scale was used for quality assessment of the studies. Studies were synthesized based on the type...
International Journal of Hygiene and Environmental Health
Environmental Epidemiology, 2019
Introduction: Phthalates are a group of high production chemicals, generally used as plasticizers... more Introduction: Phthalates are a group of high production chemicals, generally used as plasticizers and odor enhancers. Phthalates cross the blood-placenta barrier and are associated with deficits in cognitive functions and behavior problems in offspring. We previously reported sex-specific associations with motor function when phthalates are considered singly. Because exposure to phthalates usually occurs as mixtures, here we assess these associations between a mixture of phthalates and motor function at age 11 years. Methods: Data come from the prospective cohort study of mothers and offspring who participated in the Columbia Center for Children's Environmental Health birth cohort (CCCEH). Seven phthalate metabolites were measured in maternal spot urine obtained during the third trimester and motor function was evaluated using the short form of the Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition (BOT-2) at the age of 11 years. We used Weighted Quartile Sum (WQS) regression models to examine the effect of phthalate metabolites in males and females separately. The models were adjusted for child age in months, child BMI, maternal race (African-American vs. Dominican), prenatal alcohol consumption, maternal demoralization score, HOME score, and urine specific gravity. In a secondary analysis we used linear regression models to examine the association between the sum of molar concentrations of both DEHP and non-DEHP metabolites, and outcomes of gross and fine motor functions. Results: 209 mother-child pairs were eligible for this analysis. A significant decrease in fine-motor functions was observed among females, but not among males, following exposure to high levels of weighted quartile sum of seven phthalate metabolites (Covariates-adjusted coefficient estimate B = −2.7, 95% Confidence Interval [CI] −4.64 to −0.75, p = 0.01 for females [n = 116] and B = −1.63, 95%CI −3.94 to 0.69, p = 0.16 for males [n = 93]). The most highly weighted phthalate metabolites, associated with fine-motor functions among females, were MBP, MBZP, and MIBP, all non-DEHP phthalates. No significant associations were found between the weighted quartile sum of seven phthalate metabolites and gross-motor functions at the age of 11 years for males (B = −0.81, 95%CI −1.17 to 1.96, p = 0.23). With the molar sum of four non-DEHP phthalates as main predictor of linear regression models, we found significant decrease in gross and fine motor functions among females prenatally exposed to non-DEHP phthalates B = −0.98, 95%CI −1.98 to 0.03, p = 0.05 and B = −0.85, 95%CI −1.49 to −0.20, p = 0.01, respectively). Conclusions: Phthalate exposure during pregnancy was associated with decreased motor functions among 11year-old girls.
BMC Nutrition, 2017
Background: Despite global efforts, stunting remains a public health problem in several developin... more Background: Despite global efforts, stunting remains a public health problem in several developing countries. The prevalence of stunting among 0-to 5-year-old children in Armenia has increased from 17% in 2000 to 19% in 2010. A baseline study was conducted among preschool children in Berd, a region near the northeastern border of Armenia that has experienced intermittent military tension for over 20 years. Methods: We conducted a cross-sectional study including 594 children aged 6-month-6 years old and their caregivers in our analysis, to assess the prevalence and determinants of stunting. We calculated the anthropometric measurements and hemoglobin levels of children; analyzed children's stool and conducted a survey with children's caregivers. We employed the hierarchical logistic regression model to explore the predictors of stunting among 25-72 months old children and multivariable logistic regression models to investigate the predictors of stunting among 6-24 months old children. Individual and residence level variables were included in the models including anemia, minimum dietary diversity, mothers' height, the overall duration of breastfeeding, birthweight, child's history of diarrhea and mean socioeconomic score. Results: The prevalence of stunting was significantly higher among the 6-24 months old children (13.3%) compared to the children aged 25-72 months old (7.8%). We did not find any differences in the prevalence of stunting by place of residence in either age group. The 6-24 months old children who consumed at least four food groups during the previous day (minimum dietary diversity) had 72% lower odds of being stunted (p < 0.05). Each kilogram increase in birthweight was associated with 76% lower odds of being stunted (OR = 0.24, p < 0.01). Mother's height significantly decreased the odds of stunting among the children 25-72-months old (OR = 0.86, p < 0.001). BMI was also a significant predictor of stunting among both age-groups. Conclusions: The study results highlight the significance of mother's height, birthweight, and adequate complementary feeding to reduce stunting. Further studies are needed to determine the possible association of anemia and stunting with the ongoing conflict in the region, as well as socioeconomic conditions and food insecurity in the region.
European Journal of Public Health, 2016
European Journal of Public Health, 2020
Background The nonmedical use of opioids during pregnancy, either those prescribed or obtained il... more Background The nonmedical use of opioids during pregnancy, either those prescribed or obtained illegally, is a worldwide public health issue. Opioids pass through the placental barrier, which can expose the fetus to maternal opioid use; opioid-exposed babies may experience Neonatal Abstinence Syndrome (or Neonatal Opioid Withdrawal). We conducted a systematic review and meta-analysis to investigate how maternal opioid use during pregnancy may impact infants' birth outcomes. Methods We searched PubMed, Embase, PsycInfo, and the Web of Science, and identified 90 articles that met our inclusion criteria. Cohort, case-control and cross-sectional studies comparing birth outcomes of any opioid-exposed group (prescribed or obtained illegally) and a non-exposed comparison group were eligible for our systematic review. An adapted version of the Newcastle-Ottawa-Scale was used for quality assessment of the studies. Due to high heterogeneity between studies, we used random effects models t...
Public Health Nutrition, 2019
Objective: We investigated short- and long-term indicators of malnutrition and diet before and af... more Objective: We investigated short- and long-term indicators of malnutrition and diet before and after the community-based ‘Breaking the Cycle of Poverty’ multidisciplinary intervention. Design: A historically and geographically controlled study using data collected in 2013 and 2016. We compared the prevalence of short-term indicators (anaemia, breast-feeding duration and minimum dietary diversity) and long-term indicators (stunting and wasting) in exposed communities at two time points. We then compared these factors in geographic areas exposed or not exposed to intervention. We conducted logistic regression analyses on the 2016 sample to measure associations between living in intervention communities and child growth indicators. Setting: Berd region, a chronic conflict zone near the north-eastern border of Armenia and Azerbaijan. Participants: Children aged 6 months to 6 years. Results: Analyses included data from 2013 comprising 382 children, and data from 2016 comprising 348 child...
Social Psychiatry and Psychiatric Epidemiology
Background Preliminary country-specific reports suggest that the COVID-19 pandemic has a negative... more Background Preliminary country-specific reports suggest that the COVID-19 pandemic has a negative impact on the mental health of the healthcare workforce. In this paper, we summarize the protocol of the COVID-19 HEalth caRe wOrkErS (HEROES) study, an ongoing, global initiative, aimed to describe and track longitudinal trajectories of mental health symptoms and disorders among health care workers at different phases of the pandemic across a wide range of countries in Latin America, Europe, Africa, Middle-East, and Asia. Methods Participants from various settings, including primary care clinics, hospitals, nursing homes, and mental health facilities, are being enrolled. In 26 countries, we are using a similar study design with harmonized measures to capture data on COVID-19 related exposures and variables of interest during two years of follow-up. Exposures include potential stressors related to working in healthcare during the COVID-19 pandemic, as well as sociodemographic and clinical factors. Primary outcomes of interest include mental health variables such as psychological distress, depressive symptoms, and posttraumatic stress disorders. Other domains of interest include potentially mediating or moderating influences such as workplace conditions, trust in the government, and the country's income level. Results As of August 2021, ~ 34,000 health workers have been recruited. A general characterization of the recruited samples by sociodemographic and workplace variables is presented. Most participating countries have identified several health facilities where they can identify denominators and attain acceptable response rates. Of the 26 countries, 22 are collecting data and 2 plan to start shortly. Conclusions This is one of the most extensive global studies on the mental health of healthcare workers during the COVID-19 pandemic, including a variety of countries with diverse economic realities and different levels of severity of pandemic and management. Moreover, unlike most previous studies, we included workers (clinical and non-clinical staff) in a wide range of settings.
Adapting continuing medical education for postconflict areas: assessment in Nagorno Karabagh- a q... more Adapting continuing medical education for postconflict areas: assessment in Nagorno Karabagh- a qualitative study
ISEE Conference Abstracts, 2021
European Journal of Public Health, 2013
Armenian demographic and health surveys in 2000, 2005, 2010 showed increasing chronic under nutri... more Armenian demographic and health surveys in 2000, 2005, 2010 showed increasing chronic under nutrition (anemia and stunting) among 0-6yo children. According to World Bank, a 1% loss in adult height due to childhood stunting is associated with a 1.4% loss in economic productivity. In 2013 Fund for Armenian Relief of America started a program to fight the chronic under nutrition in 0-6yo children in Tavush - a poor region near Armenia’s north-eastern border which has experienced intermittent military tensions for over 20 years.
As a need assessment a cross sectional study of 6m-6yo children (n = 670) was performed, which included measurement of blood hemoglobin, intestinal parasitic infections, anthropometric measurements and survey among caregivers and a cross sectional study of 18-29 yo women (n = 562), which included measurement of blood hemoglobin and self-administrated survey.
The prevalence of stunting among the 6-24mo children was found to be 12.1% in rural and 14.3% in urban communities. Among 6m-6 yo children the prevalence of anemia and helminthoses in the urban communities were 15.9% and 13.9% respectively, in rural communities - 20.8% and 25.8% respectively. Anemia among 18-29 yo women was 12.1%.
The first study identified key determinants associated with stunting in this vulnerable region. Consumption of diverse (at least 4) food groups was found to have a protective role on stunting.
The second study showed that, despite the relatively low rate of anemia, lack of knowledge among women of reproductive age about the women's health remains disturbing.
These findings led to the design of professional and community trainings on maternal and children’s health, as well as multidimensional interventions - case management, balanced food provision in preschools, healthcare facilities improvement, community economic development, community education improvement.