Faculty Bibliography

ABSTRACT: A wealth of scientific knowledge is being generated in sleep and circadian science. In order for us to realize the return on investment for such scientific knowledge and to improve the health of the nation, we need to disseminate and implement research findings into practice. An implementation gap - termed a "quality chasm" by the Institutes of Medicine - separates the scientific knowledge we possess and the implementation of such knowledge into preventative interventions or healthcare treatments. It is frequently reported that a time lag of 17 years transpires before medical research reaches clinical practice. The rapid development of new therapies and devices for sleep and circadian disorders, the emergence of wearable devices and mobile health, combined with the mounting interest in sleep from the public and technology industries, present a transformative opportunity for sleep and circadian science researchers. In order to capitalize on this opportunity, the Sleep Research Society and the National Institutes of Health partnered to organize a workshop focused on the translation of evidence-based interventions for sleep and circadian disorders into practice strategies that benefit population health and patient outcomes. The workshop drew on the collective expertise of implementation scientists and sleep scientists in the areas of insomnia, sleep-disordered breathing, and adolescent sleep health. Together, they identified implementation gaps, effective interventions, implementation strategies and relevant outcomes and created a set of recommendations that could accelerate late-stage translation of sleep and circadian rhythms research findings to benefit public health. This white paper represents the proceedings and consensus developed at the workshop. The recommendations for high-priority implementation research are targeted at sleep and implementation researchers, educators, patients, professional societies, industry partners, funding-decision and policy makers. The major recommendations for implementation science in sleep and circadian sciences were to address the following high priority future research needs: (1) Costs and economic benefits associated with screening, diagnosing, treating insomnia across different systems (health care system, employers, etc.). (2) Promoting health literacy and education of patients, providers and community stakeholders regarding obstructive sleep apnea. (3) Increase the proportion of students in grades 9 through 12 who get sufficient sleep and (4) Perform trials aimed at improving adherence to treatments for sleep-disordered breathing (particularly evaluating cognitive therapy approaches). The fourth priority area was identified as an important barrier to implementation science efforts in sleep.

BACKGROUND/AIMS: Stroke is a leading cause of premature death and disability, and increasing the proportion of individuals who are aware of stroke symptoms is a target objective of the Healthy people 2020 project. METHODS: We used data from the 2014 Supplement of the National Health Interview Survey (NHIS) to assess the prevalence of stroke symptom knowledge and awareness. We also tested, using a logistic regression model, the hypothesis that individuals who have knowledge of all 5 stroke symptoms will be have a greater likelihood to activate Emergency Medical Services (EMS) if a stroke is suspected. RESULTS: From the 36,697 participants completing the survey 51% were female. In the entire sample, the age-adjusted awareness rate of stroke symptoms/calling 911 was 66.1%. Knowledge of the 5 stroke symptoms plus importance of calling 911 when a stroke is suspected was higher for females, Whites, and individuals with health insurance. Stroke awareness was lowest for Hispanics, Blacks, and survey participants from Western US region. CONCLUSION: The findings allude to continuing differences in the knowledge of stroke symptoms across race/ethnic and other demographic groups. Further research will confirm the importance of increased health literacy for Stroke management and prevention in minority communities.

Aspiring junior investigators from groups underrepresented in the biomedical sciences face various challenges as they pursue research independence. However, the biomedical research enterprise needs their participation to effectively address critical research issues such as health disparities and health inequities. In this article, we share a research education and mentoring initiative that seeks to address this challenge: Programs to Increase Diversity among Individuals Engaged in Health Related Research (PRIDE), funded by the National Heart, Lung, and Blood Institute (NHLBI). This longitudinal research-education and mentoring program occurs through summer institute programs located at US-based academic institutions. Recruited participants are exposed to didactic and lab-based research-skill enhancement experiences, with year-round mentoring over the course of two years. Mentor-mentee matching is based on shared research interests to promote congruence and to enhance skill acquisition. Program descriptions and sample narratives of participants' perceptions of PRIDE's impact on their career progress are showcased. Additionally, we highlight the overall program design and structure of four of seven funded summer institutes that focus on cardiovascular disease, related conditions, and health disparities. Mentees' testimonials about the value of the PRIDE mentoring approach in facilitating career development are also noted. Meeting the clinical and research needs of an increasingly diverse US population is an issue of national concern. The PRIDE initiative, which focuses on increasing research preparedness and professional development of groups underrepresented in the biomedical research workforce, with an emphasis on mentoring as the critical approach, provides a robust model that is impacting the careers of future investigators.

BACKGROUND: The global prevalence of skin depigmentation/skin bleaching among blacks, estimated at 35%, is on the rise and is associated with a host of negative health and medical consequences. Current etiological approaches do not fully capture the emotional and psychological underpinnings of skin bleaching. The current study investigated the potential mediating role of depression, or post-traumatic stress symptoms (avoidance and hyperarousal) on the relationship between childhood physical and sexual abuse (CPSA) and skin bleaching. METHODS: A total of 1226 university participants (ages 18-30 years and 63.4% female) from three Caribbean countries (Jamaica, Barbados, and Grenada) provided data for the current analysis. They all completed self-reported measures of general demographic information along with the short screening scale for posttraumatic stress disorder (DSM-IV), childhood trauma, and skin bleaching questions. RESULTS: The prevalence of skin bleaching in our study was 25.4%. Our findings showed that individuals who bleached their skin were more likely to have been abused as children (21.6% versus 13.5%, p<0.001), were more likely to have significant symptoms of trauma (34.1% versus 24.0%, p=0.005), and were more likely to have significant depression (43.7% versus 35.1%, p=0.032). We found that trauma-related hyperarousal symptoms positively mediated the relationship between childhood physical and sexual abuse and skin bleaching (Indirect Effect=0.03, p<0.05), while avoidance (Indirect Effect=0.000, p>0.05) and depressive (Indirect Effect=0.005, p>0.05) symptoms did not. CONCLUSION: The presence of trauma symptoms and childhood physical and sexual abuse (CPSA) may increase the likelihood of skin bleaching. Findings suggest that further exploration is needed to ascertain if the presence of skin bleaching warrants being also screened for trauma.

As the burden of noncommunicable diseases (NCDs) rises in settings with an equally high burden of infectious diseases in the Global South, a new sense of urgency has developed around research capacity building to promote more effective and sustainable public health and health care systems. In 2010, NCDs accounted for more than 2.06 million deaths in sub-Saharan Africa. Available evidence suggests that the number of people in sub-Saharan Africa with hypertension, a major risk factor for cardiovascular diseases, will increase by 68% from 75 million in 2008 to 126 million in 2025. Furthermore, about 27.5 million people currently live with diabetes in Africa, and it is estimated that 49.7 million people living with diabetes will reside in Africa by 2030. It is therefore necessary to centralize leadership as a key aspect of research capacity building and strengthening in the Global South in ways that enables researchers to claim their spaces in their own locations. We believe that building capacity for transformative leadership in research will lead to the development of effective and appropriate responses to the multiple burdens of NCDs that coexist with infectious diseases in Africa and the rest of the Global South.

BACKGROUND: Studies on adult population indicate shorter sleep duration in ethnic minority groups than host populations. We examined ethnic differences in sleep duration and its relationship with overweight and blood pressure (BP) among children living in Amsterdam. METHODS: Participants include 2384 children (aged 5 years) and their mothers from the Amsterdam-based longitudinal study. Sleep was categorised into short sleep (<10 h/night) and normal sleep (10-11 h/night). Linear regressions ( Beta: were used to study association between sleep duration and systolic BP (SBP) and diastolic BP (DBP). Prevalence ratios (PRs) were used to study ethnic differences in sleep duration and its association with overweight and raised BP. RESULTS: Minority groups reported shorter sleep duration compared to native Dutch, with prevalence ranging from 11.3% in Dutch to 53.1% in Ghanaians. Age-adjusted PRs ranged from 3.38 (95%CI 2.63-4.34) in Moroccans to 4.78 (95%CI 3.36-6.82) in Ghanaian compared with Dutch children. Increased prevalence of overweight was observed among children with short sleep in Dutch and Moroccans only, but this risk was no longer statistically significant after further adjustment for socioeconomic status. Short sleep was not related to SBP and DBP in all groups. No relationship was observed between short sleep and raised BP except for African Surinamese (3.65, 95% CI 1.23-10.8). CONCLUSION: Like adults, children from ethnic minority populations sleep less hours than Dutch children. Efforts to improve ethnic inequalities in sleep hygiene should also include children at younger age. Associations as reported in adults with overweight and BP could not consistently be replicated in children, however.

Introduction: Poor adherence to evaluation and treatment of obstructive sleep apnea (OSA) is a public health challenge. Despite higher prevalence of OSA, blacks are less likely to adhere to physician-recommended OSA care than are whites. Methods: Among black patients with metabolic syndrome, we compared, in an RCT, effectiveness of a telephone-delivered culturally and linguistically tailored OSA health messages over 6 months (Intervention) versus standard patient education (Control) in improving adherence to recommended OSA care. We hypothesized that patients randomized to the intervention arm would exhibit greater adherence to OSA consultation, evaluation, and treatment than those in the control arm. We also evaluated the predictive role of baseline sociodemographics, health risks, comorbidity, and psychosocial factors on adherence status using multivariate-adjusted regression analyses. Results: 380 patients (mean age = 59yrs; 71%, women) were enrolled with 80% retention rate (intervention = 160 and control = 143). Of the sample, 69.4% of patients exposed to the intervention attended initial consultations, compared with 36.7% of patients in the control arm (p < .001); 74.7% versus 66.7% of patients in the intervention and control arms, respectively, completed diagnostic evaluations (p = 0.46), while 86.4% versus 88.9% in the intervention and control arm, respectively, adhered to OSA treatment. Based on adjusted logistic regression, patients in the intervention arm were 3.17 times (95% CI = 1.68-5.99, p < 0.001) more likely to have initial consultations, relative to controls. Treatment self-efficacy was the strongest predictor of OSA adherence (OR = 1.11, 95% CI = 1.03-1.20, p < 0.01). Adjusted models revealed no significant differences between the two arms regarding adherence to OSA evaluation and treatment. Conclusion: The culturally and linguistically tailored OSA health messages were successful in improving initial consultation for OSA diagnosis. However, once patients were in treatment, there was no difference in OSA adherence rates between the two groups