Faculty Bibliography

Little is known about the association between chronic illness and suicidal ideation (SI) among Dominicans living in the United States. This study used data from a community survey of 2753 Dominican adults in New York City. SI included thoughts of self-harm or being better off dead in the past month. Chronic physical illness burden was categorized as having 0, 1, or 2+ diagnosed conditions. Adjusted logistic regressions evaluated the association between number of conditions and SI, overall and stratified by sex and age. Adjusted models yielded a strong association between chronic illness burden and SI among men [odds ratio (OR) 5.57, 95 % confidence interval (CI) 2.19-14.18] but not women (OR 0.80, 95 % CI 0.50-1.29; interaction p = 0.011). The association of interest did not differ significantly between younger and older adults. Screening for SI in health care practice, particularly among Dominican men with multiple chronic health conditions, may be warranted.

Background and Aims: Secondary stroke prevention strategies have proven suboptimal in underserved and minority populations. The Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) trial tested the efficacy of a culturally-tailored, innovative, skills-based intervention focused on risk perception, medication adherence, and patient-physician communication (vs. usual care enhanced with educational material [EUC]) on systolic blood pressure (SBP) reduction among mild/moderate stroke/TIA patients at 1 year post-discharge. Method: We assessed the difference in mean SBP reduction between trial arms, overall and by race/ethnicity, among those with prehypertension/ hypertension at baseline using linear regression, adjusting for any characteristics that differed between trial arms at baseline. Results: A total of 321 of 552 stroke/TIA patients assessed at baseline were included in analyses (intervention, n=163; EUC, n=158; 29% white, 33% black, 33% Hispanic). Overall, there was a trend toward greater mean BP reduction in the intervention vs. EUC group (12.6 vs. 8.4 mmHg, p=0.101). Mean SBP reduction was significantly greater in the intervention vs. EUC group among Hispanics (15.6 vs. 1.7 mmHg, p=0.002). Among Hispanics, after adjusting for age, interview language, education, place of birth, and baseline SBP, mean SBP reduction was 8.2 mmHg greater in the intervention vs. EUC group (p=0.041). Mean SBP reduction did not differ significantly between trial arms among non- Hispanics. Conclusion: Few behavioral intervention studies in stroke survivors have reported significant long-term differences in vascular risk reduction, and fewer have focused on a skills-based approach. Culturally-tailored, skills-based interventions may be more useful than knowledge-focused interventions in achieving sustained vascular risk reduction and addressing race/ethnic stroke disparities

OBJECTIVE:To examine frequent snoring, sleepiness, and sleep duration with baseline and longitudinal performance on neuropsychological (NP) battery. METHODS:The analysis consists of 711 participants of the Northern Manhattan Study (NOMAS) with sleep data and NP assessment (age 63 ± 8 years, 62% women, 18% white, 17% black, 67% Hispanic) and 687 with repeat NP testing (at a mean of 6 ± 2 years). The main exposures were snoring, sleepiness, and sleep duration obtained during annual follow-up. Using factor analysis-derived domain-specific Z scores for episodic memory, language, executive function, and processing speed, we constructed multivariable regression models to evaluate sleep symptoms with baseline NP performance and change in performance in each NP domain. RESULTS:In the cross-sectional analysis, adjusting for demographics and the NOMAS vascular risk score, participants with frequent snoring had worse executive function (β = -12; p = 0.04) and processing speed (β = -13; p = 0.02), but no difference in with episodic memory or language. Those with severe daytime sleepiness (β = -26; p = 0.009) had worse executive function, but no changes in the other NP domains. There was no cross-sectional association between sleep duration and NP performance. Frequent snoring (β = -29; p = 0.0007), severe daytime sleepiness (β = -29; p = 0.05), and long sleep duration (β = -29; p = 0.04) predicted decline in executive function, adjusting for demographic characteristics and NOMAS vascular risk score. Sleep symptoms did not explain change in episodic memory, language, or processing speed. CONCLUSIONS:In this race-ethnically diverse community-based cohort, sleep symptoms led to worse cognitive performance and predicted decline in executive function.