Faculty Bibliography

BACKGROUND:Given the growing burden of cardiovascular diseases in sub-Saharan Africa, global donors and governments are exploring strategies for integrating evidence-based cardiovascular diseases prevention into HIV clinics. We assessed the capabilities, motivations and opportunities that exist for HIV clinics to apply evidence-based strategies for hypertension control among people living with HIV (PLHIV) in Nigeria. METHODS:We used a concurrent Quan-Qual- study approach (a quantitative first step using structured questionnaires followed by a qualitative approach using stakeholder meetings).We invited key stakeholders and representatives of HIV and non-communicable disease organizations in Lagos, Nigeria to 1) assess the capacity of HIV clinics (n = 29) to, and; 2) explore their attitudes and perceptions towards implementing evidence-based strategies for hypertension management in Lagos, Nigeria (n = 19)The quantitative data were analyzed using SPSS whereas responses from the stakeholders meeting were coded and analyzed using thematic approach and an implementation science framework, the COM-B (Capabilities, Opportunities, Motivations and Behavior) model, guided the mapping and interpretation of the data. RESULTS:Out of the 29 HIV clinics that participated in the study, 28 clinics were public, government-owned facilities with 394 HIV patients per month with varying capabilities, opportunities and motivations for integrating evidence-based hypertension interventions within their services for PLHIV. Majority of the clinics (n = 26) rated medium-to-low on the psychological capability domains, while most of the clinics (n = 25) rated low on the physical capabilities of integrating evidence-based hypertension interventions within HIV clinics. There was high variability in the ratings for the opportunity domains, with physical opportunities rated high in only eight HIV clinics, two clinics with a medium rating and nineteen clinics with a low rating. Social opportunity domain tended to be rated low in majority of the HIV clinics (n = 21). Lastly, almost all the HIV clinics (n = 23) rated high on the reflective motivation domain although automatic motivations tended to be rated low across the HIV clinics. CONCLUSION/CONCLUSIONS:In this study, we found that with the exception of motivations, the relative capabilities whether physical or psychological and the relative opportunities for integrating evidence-based hypertension intervention within HIV clinics in Nigeria were minimal. Thus, there is need to strengthen the HIV clinics in Lagos for the implementation of evidence-based hypertension interventions within HIV clinics to improve patient outcomes and service delivery in Southwest Nigeria.

Introduction: Blunted heart rate dip has been shown to increase the risk of cardiovascular and non-cardiovascular morbidity and mortality among people with chronic kidney disease (CKD). Despite increased access to 24 hour ambulatory blood pressure monitoring, relatively few studies on sleep heart rate exist especially among native black Africans. Objectives: The purpose of the study was to assess the prevalence and clinical correlates of non-dipping heart rate in CKD patients using data from CRECKID study. Methods: All the participants had a 24-hour ambulatory blood pressure monitoring done using SpaceLabs ABPM (SpaceLabs Healthcare, Issaquah, WA). Blood samples were analyzed for fasting plasma glucose, lipid profile, electrolytes, urea and creatinine. Hear rate dipping was estimated as (1 - night time heart rate/daytime heart rate) x100. Normal dipping of heart rate was defined as >10% decrease in heart rate. Estimated glomerular filtration rate (eGFR) was calculated using CKD-EPI Creatinine Equation and CKD was defined as eGFR<60ml/min/1.73m². Results: Four hundred and seven consented participants comprising of 225 (55.3%) women, 242 (59.5%) hypertensive without CKD, 90 (22.1%) normotensive and 75 (18.4%) CKD patients with mean age 55.3+/-14.7 years with complete data were analyzed. A total of 172 (42.3%) participants were non-dippers. Compared to heart rate dippers, non-dippers had higher mean clinic and ambulatory blood pressure parameters, creatinine, and triglyceride with lower eGFR, HDLc, and heart rate dipping (3.15+/-5.2 vs 19.28+/-13.9, p<0.0001). Non-dippers were more common among men (47.9% vs 37.8%; p=0.042). Four out of every five CKD patients were non-dippers compared with a third and one-fifth among hypertensives and normotensives, respectively (p< 0.0001). eGFR was an independent predictor of heart rate non-dipping (OR 1.03, CI 1.003-1064, p=0.033). Conclusion: This study highlights high prevalence of heart rate non-dipping worse in CKD patients. Non-dippers had more constellations of cardiovascular risk factors and eGFR was an independent correlates of heart rate non-dipping. A larger prospective study is required for determination of prognostic relevance of these findings. Disclosure of Interest: None declared

Poor outcomes for breast cancer in Ghana have been attributed to late presentation of symptoms at biomedical facilities. This study explored factors accounting for delays in initiation of breast cancer treatment at the Korle-Bu Teaching Hospital in Accra. Focus group discussions were conducted with 20 women with breast cancer. A theory-driven thematic analysis identified three multilevel factors influencing treatment seeking delays: (1) patient (e.g. misinterpretation of symptoms, fear), (2) healthcare provider (e.g. negative attitudes) and (3) health systems (e.g. shortage of medicines). Addressing treatment delays will require multilevel interventions, including culturally congruent education, psychosocial counselling/support and strengthening health systems.

BACKGROUND:The purpose of this systematic review and meta-analysis on child-to-parent communication of stroke information (Child-Mediated Stroke Communication, CMSC) is to provide the highest levels of evidence supporting the role of this approach in community education. METHODS:Databases such as PubMed, Google Scholar, PsycINFO, Web of Science, MEDLINE, and CINHAL were searched to gather information on CMSC followed by a meta-analysis. The eligibility criteria were as follows: (a) children aged 9-15years and parents, (b) randomized or nonrandomized trials, and (c) outcome variables that included the proportions of parents answering the pretest and post-test on stroke knowledge regarding risk factors, symptoms, and what to do in the event of stroke. RESULTS:Of the 1668 retrieved studies, 9 articles were included. Meta-analytical findings yielded that the proportions of correct answers for stroke symptoms and its risk factors among parents were 0.686 (95% CI: 0.594-0.777) at baseline and increased to 0.847 (95% CI: 0.808-0.886) at immediate post-test and 0.845 (95% CI: 0.804-0.886) delayed post-test. The proportions of correct answers for behavioral intent to call 911 when witnessing stroke was 0.712 (95% CI: 0.578-0.846) at baseline, rising to 0.860 (95% CI: 0.767-0.953) at immediate post-test, and 0.846 (95% CI: 0.688-1.004) at delayed post-test. CONCLUSIONS:CMSC is effective for educating families. More work is needed to increase the use of validated stroke literacy instruments and behavioral theory, and to reduce parental attrition in research studies.

BACKGROUND:Therapeutic lifestyle change (TLC) is a recommended treatment for patients with hypertension, but its effectiveness in community-based settings remains untested, particularly in black churches-an influential institution for health promotion in black communities. METHODS AND RESULTS/RESULTS:The FAITH study (Faith-Based Approaches in the Treatment of Hypertension) evaluated the comparative effectiveness of a TLC intervention plus motivational interviewing (MINT) sessions versus health education (HE) alone, on blood pressure (BP) reduction among blacks with uncontrolled hypertension. Data were collected on 373 participants meeting eligibility criteria (self-identification as black, age ≥18 years, self-reported diagnosis of hypertension, and uncontrolled BP [BP ≥140/90 or ≥130/80 mm Hg with diabetes mellitus or chronic kidney disease]) from 32 New York City churches. The MINT-TLC intervention plus motivational interviewing treatment comprised 11 weekly group sessions on TLC plus 3 MINT sessions delivered monthly by lay health advisors. The HE control group received 1 TLC session plus 10 sessions on health topics delivered by local experts. The outcomes were BP reduction at 6 months (primary) and BP control and BP reduction at 9 months (secondary). The sample mean age was 63 years; 76% women, with mean BP of 153/87 mm Hg. Using linear mixed-effects regression models, the MINT-TLC intervention plus motivational interviewing group had a significantly greater systolic BP reduction of 5.79 mm Hg compared with the HE group at 6 months ( P=0.029). The treatment effect on systolic BP persisted at 9 months but had reduced significance (5.21 mm Hg; P=0.068). The between-group differences in diastolic BP reduction (0.41 mm Hg) and mean arterial pressure (2.24 mm Hg) at 6 months were not significant. Although the MINT-TLC intervention plus motivational interviewing group had greater BP control than the HE group at 9 months, the difference was not statistically significant (57.0% versus 48.8%; odds ratio, 1.43; 95% CI, 0.90-2.28). CONCLUSIONS:A community-based lifestyle intervention delivered in churches led to significantly greater reduction in systolic BP in hypertensive blacks compared with HE alone. CLINICAL TRIAL REGISTRATION/BACKGROUND:URL: https://www.clinicaltrials.gov . Unique identifier: NCT01065831.

BACKGROUND:Compared to whites, blacks are at increased risk for obstructive sleep apnea (OSA) yet less likely to adhere to physician-recommended sleep assessment and treatment. Poor OSA health literacy and lack of social support to navigate the current healthcare system are two potential barriers to adequate OSA care. This study is designed to address these barriers by evaluating the effectiveness of a peer-based sleep health education program on adherence to OSA assessment and treatment among blacks at risk for OSA. METHOD/DESIGN/METHODS:In a two-arm, randomized controlled trial, we will ascertain the effectiveness of peer-based sleep health education and social support in increasing OSA evaluation and treatment rates among 398 blacks at low to high OSA risk. Participants at risk of OSA will receive quality controlled, culturally, and linguistically tailored peer education based on Motivational Enhancement principles over a period of 12 months. During this 12-month period, participants are encouraged to participate in a sleep home study to determine risk of OSA and, if found to be at risk, they are invited to undergo a diagnostic sleep assessment at a clinic. Participants who are diagnosed with OSA and who are prescribed continuous positive airway pressure treatment will be encouraged, through peer-based education, to adhere to recommended treatment. Recruitment for the project is ongoing. DISCUSSION/CONCLUSIONS:The use of a culturally tailored sleep health education program, peer health educators trained in sleep health, and home-based sleep assessment are novel approaches in improving OSA assessment and treatment adherence in blacks who are significantly at risk for OSA. Empirical evidence from this trial will provide clinical and population level solutions on how to improve and increase assessment and treatment of OSA among blacks. TRIAL REGISTRATION/BACKGROUND:NCT02427815 . Registered on 20 April 2015. ClinicalTrials.gov title: Sleep Health Education and Social Support Among Blacks With OSA.

BACKGROUND:Elevated stress is associated with adverse cardiovascular disease outcomes and accounts in part for the poorer recovery experienced by women compared with men after myocardial infarction (MI). Psychosocial interventions improve outcomes overall but are less effective for women than for men with MI, suggesting the need for different approaches. Mindfulness-based cognitive therapy (MBCT) is an evidence-based intervention that targets key psychosocial vulnerabilities in women including rumination (i.e., repetitive negative thinking) and low social support. This article describes the rationale and design of a multicenter randomized controlled trial to test the effects of telephone-delivered MBCT (MBCT-T) in women with MI. METHODS:We plan to randomize 144 women reporting elevated perceived stress at least two months after MI to MBCT-T or enhanced usual care (EUC), which each involve eight weekly telephone sessions. Perceived stress and a set of patient-centered health outcomes and potential mediators will be assessed before and after the 8-week telephone programs and at 6-month follow-up. We will test the hypothesis that MBCT-T will be associated with greater 6-month improvements in perceived stress (primary outcome), disease-specific health status, quality of life, depression and anxiety symptoms, and actigraphy-based sleep quality (secondary outcomes) compared with EUC. Changes in mindfulness, rumination and perceived social support will be evaluated as potential mediators in exploratory analyses. CONCLUSIONS:If found to be effective, this innovative, scalable intervention may be a promising secondary prevention strategy for women with MI experiencing elevated perceived stress.

BACKGROUND:Little is known about the prevalence and correlates of burnout among providers who work in small independent primary care practices (<5 providers). METHODS:We conducted a cross-sectional analysis by using data collected from 235 providers practicing in 174 small independent primary care practices in New York City. RESULTS:= .034). CONCLUSION/CONCLUSIONS:The burnout rate was relatively low among our sample of providers compared with previous surveys that focused primarily on larger practices. The independence and autonomy providers have in these small practices may provide some protection against symptoms of burnout. In addition, the relationship between adaptive reserve and lower rates of burnout point toward potential interventions for reducing burnout that include strengthening primary care practices' learning and development capacity.