Insomnia and the eye of the beholder: are there clinical markers of objective sleep disturbances among adults with and without insomnia complaints?

Previous findings suggest that some who report insomnia sleep well, whereas some noncomplaining individuals sleep rather poorly. This study was conducted to determine if mood, anxiety, and sleep-related beliefs might relate to perceived sleep disturbance. Thirty-two women and 32 men (aged 40-79 years) with primary insomnia and an aged-matched sample of 61 normal sleepers (31 women, 30 men) completed 6 nocturnal sleep recordings, as well as the Beck Depression Inventory (BDI), the Trait portion of the State-Trait Anxiety Inventory (STAI-2), and the Dysfunctional Beliefs and Attitudes About Sleep Questionnaire. Sleep and interview data were used to subdivide the majority of the sample (n = 108) into objective normal sleepers and subjective insomnia sufferers who seemingly slept well and subjective normal sleepers and objective insomnia sufferers who slept poorly. The 2 subjective subgroups showed the most marked differences on most of the psychometric measures. The findings suggest that the psychological factors scrutinized in this study may mediate sleep satisfaction and/or predict objective sleep difficulties.     

Racial/Ethnic and Social Inequities in Sleep Medicine: The Tip of the Iceberg?

Purpose

It is known that racial disparities exist in terms of disease prevalence and access to health care. However, the link between race/ethnicity and sleep quality is often under-recognized.

Support and influence in the context of diabetes management: do racial/ethnic differences exist?

This study examined the sources and frequency of, and dietary behavioral responses to, health-related social support and control in a racially/ethnically diverse sample of 1,361 adults with type 2 diabetes. Spouses were the most frequently reported sources of support/control for all racial/ethnic groups examined. Mexican Americans and Vietnamese Americans received more support/control compared to non-Hispanic whites. All types of social involvement were associated with good dietary behavior for Mexican Americans, whereas only support was associated with good dietary behavior for non-Hispanic whites. The findings underscore the importance of considering racial/ethnic differences in examining social network members' involvement in chronic disease management.     

Immunometabolism: Is it under the eye of the clock?

Molecular clocks allow an organism to track time of day, providing the means to anticipate and respond to the daily changes within the environment. In mammals the molecular clock consists of a network of proteins that form auto-regulatory feedback loops that drive rhythms in physiology and behavior. In recent times the extent to which the molecular clock controls key metabolic and immune pathways has begun to emerge. For example, the main clock protein BMAL1 has been linked to mitochondrial metabolism, mitochondrial dynamics and various host defense pathways. The molecular clock may function to integrate daily metabolic changes driven by feeding-fasting to immune function and output. Understanding how the clock intersects with metabolic pathways within immune cells to affect immune phenotypes will have broad implications for the management of metabolic, inflammatory and infectious diseases.     

Are there ethnic differences in deletions in the dystrophin gene?

We studied 160 cases of Duchenne muscular dystrophy (DMD) drawn from all parts of India, using multiplex PCR of 27 exons. Of these, 103 (64.4%) showed intragenic deletions. Most (69.7%) of the deletions involved exons 45–51. The phenotype of cases with deletion of single exons did not differ significantly from those with deletion of multiple exons. The distribution of deletions in studies from different countries was variable, but this was accounted for either by the small number of cases studied, or by fewer exons analyzed. It is concluded that there is likely to be no ethnic difference with respect to deletions in the DMD gene. Am. J. Med. Genet. 68:152–157, 1997 © 1997 Wiley-Liss, Inc.     

Camptodactyly,myopia, and fibrosis of the medial rectus of the eye in two sibs born to consanguineous parents: Autosomal recessive entity?

Unaffected but consanguineous parents suggest autosomal recessive inheritance of a previously apparently undescribed syndrome of camptodactyly, fibrosis of the medial rectus muscle of the eye, severe myopia, facial anomalies, joint contractures, and mild scoliosis in a 13-year-old Turkish girl and her 11-year-old brother. The girl also had ptosis. Am. J. Med. Genet. 77:28–30, 1998. © 1998 Wiley-Liss, Inc.     

Neural mismatch indices of vowel discrimination in monolingually and bilingually exposed infants: Does attention matter?

Neurophysiological studies of infant speech suggest that mismatch responses (MMRs) have predictive value for later language. Their value, however, is diminished because unexplained differences in the MMR patterns are seen across studies. The current study aimed to identify the functional nature of infant MMRs by recording event-related-potentials (ERPs) to an infrequent English vowel change in internal or final positions of a sequence of ten vowels in six-month-old monolingually and bilingually exposed infants. Increased negativity of the MMR (infrequent minus frequent) was found in final compared to internal positions and correlated with an index of increased attention to the final position. This pattern helps explain the overall greater negativity to the speech sounds in the bilingually exposed female infants. These findings substantially advance our understanding of neural indices of speech perception development and show promise for furthering our understanding of bilingual language development.     

Closing the gap in representation of racial and ethnic minorities in pain medicine: A 2018–2019 status report

Racial health disparities persist despite increased public awareness of systemic racism. Due to the inherent subjectivity of pain perception, assessment and management, physician-patient bias in pain medicine remains widespread. It is broadly accepted that increasing racial diversity in the field of medicine is a critical step towards addressing persistent inequities in patient care. To assess the current racial demographics of the pain medicine pipeline, we conducted a cross-sectional analysis of medical school matriculants and graduates, residents, and pain fellows in 2018. Our results show that the 2018 anesthesiology residency ERAS applicant pool consisted of 46.2% non-Hispanic White, 7.0% non-Hispanic Black and 5.8% Hispanic students. The population of 2018 anesthesiology residents included 63% non-Hispanic White, 6.8% non-Hispanic Black and 5.4% Hispanic persons. Of the total eligible resident pool for pain fellowships (n = 30,415) drawn from core specialties, 44% were non-Hispanic White, 4.9% non-Hispanic Black and 5.1% Hispanic. Similar proportions were observed for pain medicine and regional anesthesia fellows. We briefly discuss the implications of the shortage of non-Hispanic Black and Hispanic representation in pain medicine as it relates to the COVID-19 pandemic and suggest approaches to improving these disparities.     

Are free radical reactions increased in the diabetic eye?

Reactive oxygen species (ROS) are thought to play a significant role in the development of diabetic retinopathy; however, no direct evidence supports ROS generation in vivo. This study used in vivo electron spin resonance (ESR) spectroscopy with a surface resonator to detect local free radical reactions. The ESR signal decay of carbamoyl-PROXYL was enhanced in the eyes of streptozotocin (STZ)-induced diabetic mice. This enhanced signal decay was suppressed by the administration of SOD or the pretreatment with aminoguanidine. We demonstrate, for the first time, specific free radical reactions in the eyes of mice with STZ-induced diabetes.     

Does ethnic identity buffer or intensify the stress of discrimination among the foreign born and U.S. born? Evidence from the Miami‐Dade Health Survey

This study examines the extent to which ethnic identity is a protective factor and buffers the stress of discrimination among the foreign born compared to the U.S. born in Miami‐Dade County. Data were drawn from the 2011 Miami‐Dade Health Survey (N = 444), which is a countywide probability sample of adults in South Florida. Two interaction effects were observed: (a) a stronger ethnic identity was associated with less distress among the foreign born than the U.S. born; and (b) a stronger ethnic identity exacerbated the relationship between everyday discrimination and distress among the U.S. born. Ethnic identity, which involves ethnic pride, participation in cultural practices, and cultural commitment or sense of belonging, was associated with better psychological well‐being among the foreign born than the U.S. born. Ethnic identity, however, was not a protective factor for the U.S. born, but rather it intensified the distressing effect of discrimination.     

New ideas about binocular coordination of eye movements: is there a chameleon in the primate family tree?

Many animals with laterally placed eyes, such as chameleons, move their eyes independently of one another. In contrast, primates with frontally placed eyes and binocular vision must move them together so that both eyes are aimed at the same point in visual space. Is binocular coordination an innate feature of how our brains are wired, or have we simply learned to move our eyes together? This question sparked a controversy in the 19(th) century between two eminent German scientists, Ewald Hering and Hermann von Helmholtz. Hering took the position that binocular coordination was innate and vigorously challenged von Helmholtz's view that it was learned. Hering won the argument and his hypothesis, known as Hering's Law of Equal Innervation, became generally accepted. New evidence suggests, however, that similar to chameleons, primates may program movements of each eye independently. Binocular coordination is achieved by a neural network at the motor periphery comprised of motoneurons and specialized interneurons located near or in the cranial nerve nuclei that innervate the extraocular muscles. It is assumed that this network must be trained and calibrated during infancy and probably throughout life in order to maintain the precise binocular coordination characteristic of primate eye movements despite growth, aging effects, and injuries to the eye movement neuromuscular system. Malfunction of this network or its ability to adaptively learn may be a contributing cause of strabismus.     

Immunity and age: living in the past?

Increasing age is associated with a decreasing ability to mediate effective immune responses to newly encountered antigens. It is generally believed that this reflects the age-associated decline in the number, repertoire and function of available naive T cells. Here, we propose that naive T cells become increasingly irrelevant to the immune system, and that responses to newly encountered antigens are progressively dominated by cross-reactive memory T cells as the individual ages. In addition, we propose that the majority, if not all, of the response to newly encountered antigens in the elderly is mediated by cross-reactive memory T cells. This predicts highly stochastic responses to new infections that should vary between individuals, and has important implications for vaccination strategies in the elderly.     

Examining How Racial Discrimination Impacts Sleep Quality in African Americans: Is Perseveration the Answer?

Background: African Americans experience more problematic and disordered sleep than White Americans. Racial discrimination has been implicated in this disparity. However, the mechanisms by which discrimination disrupts sleep are unclear. It has been theorized that Perseverative Cognition (PC), characterized by recurrent patterns of reflective (i.e., rumination) and anticipatory (i.e., worry) negative thinking about personally relevant stressors, may reflect the functional mechanism linking discrimination to sleep. The present study is the first to empirically examine the dual components of PC as a candidate functional mechanism in the association between racial discrimination and subjective sleep quality. Participants: Sixty-eight self-identified African American college students (55.9% female; M_age = 20.18, SD = 2.93) were recruited at a large predominantly white public university in the Midwest. Methods: The participants completed the Perceived Ethnic Discrimination Questionnaire (PEDQ), Pittsburgh Sleep Quality Index (PSQI), Penn State Worry Questionnaire (PSWQ), and Ruminative Responses Scale (RRS). Results: After adjusting for age, gender, and social class, results revealed a significant indirect effect of racial discrimination (RD) on subjective sleep quality through rumination, 95% CI [.008, .125], but not worry. RD was positively associated with rumination, b =.50, SE =.16, p = .003, and rumination, in turn, was positively associated with poorer sleep quality, b = .09, SE = .04, p = .012. Conclusions: As both RD and poor sleep quality have been directly linked to heart disease, diabetes, depression, and a number of other maladies, our findings suggest that RD, sleep, and coping strategies (e.g., rumination) employed to manage RD experiences may be important targets for addressing racial disparities in health.     

Perceived discrimination in primary care: Does Payer mix matter?

IntroductionPrevious literature has explored patient perceptions of discrimination by race and insurance status, but little is known about whether the payer mix of the primary care clinic (i.e., that is majority public insurance vs. majority private insurance clinics) influences patient perceptions of race- or insurance-based discrimination.MethodsBetween 2015-2017, we assessed patient satisfaction and perceived race- and insurance-based discrimination using a brief, anonymous post-clinic visit survey.ResultsParticipants included 3,721 patients from seven primary care clinics—three public clinics and four private clinics. Results from unadjusted logistic regression models suggest higher overall reports of race- and insurance-based discrimination in public clinics compared with private clinics. In mulvariate analyses, increasing age, Black race, lower education and Medicaid insurance were associated with higher odds of reporting race- and insurance-based discrimination in both public and private settings.ConclusionReports of race and insurance discrimination are higher in public clinics than private clinics. Sociodemographic variables, such as age, Black race, education level, and type of insurance also influence reports of race- and insurance-based discrimination in primary care.