USF Health’s Christian Brechot, MD, PhD, who leads the USF Initiative on Microbiomes, speaks with Maureen Groer, PhD, Gordon Keller Professor at the USF College of Nursing, about her research on the altered gut microbiome of premature infants. | Photo by Allison Long

Maureen Groer, PhD, looks at the health of preterm infants literally from the gut. As part of  the USF Initiative on Microbiomes, Groer studies how the beneficial balance of trillions of bacteria, viruses and other microorganisms in the digestive tract – known as the gut microbiome – might be altered in prematurely born babies, and what impact it might have on their long-term health.

“As nurses, we want to do research that translates to better health care and better health outcomes,’’ she said. “And for me, that’s mothers and infants.’’

Groer is a pediatric nurse, family nurse practitioner and the Gordon Keller Professor at the USF College of Nursing. Her work examines the molecular mechanisms underlying immunology, biology and behavior and how the “crosstalk” among these systems may affect the health of infants, children and their mothers.

Funded by a grant from the National Institutes of Health (NIH), Groer studies what happens to the equilibrium of the gut microbiome of premature babies who spend weeks, or even months, in a hospital’s neonatal intensive care unit (NICU). While there, they often receive antibiotics that can lead to dysbiosis, an imbalance in the normal microbes that live in the gut. Because no two babies are alike, treatment can be complicated.

“Everybody has a signature microbiome,’’ Groer said. “We have within our body populations of bacteria, viruses and fungi that live in a relationship that’s beneficial.”

“Every NICU has its own brand of microorganisms and they’re not the natural organisms that should be populating the gut. So, these NICU babies are at risk, and that might translate into health risks later.’’

Maureen Groer, PhD, Gordon Keller Professor in the USF College of Nursing

Most healthy babies develop a balanced gut microbiome by age 3. But when infants are born too early, the evolution of the gut may be disrupted by various factors, including delivery by Cesarean section, poor organ development, and extended time in the NICU. Dysbiosis can impair an infant’s ability to gain weight, among other conditions.

Extended time in the neonatal intensive care unit may contribute to disrupted development of a premature infant’s gut.

While prenatal hospital care provides lifesaving support, babies who spend their first weeks or months there receive multiple antibiotics, undergo stressful invasive procedures, interact less with their mothers, and typically ingest more formula milk than breast milk, which would transfer the mother’s own beneficial gut bacteria to the lactating infant. As a result, Groer said “NICU babies don’t have normal microbiomes.’’

By learning more about how a person’s estimated 30 trillion bacteria influence health, aging and disease, Groer and other researchers with the Initiative on Microbiomes hope to address some of the greatest challenges in health care.

In another study, Groer is following pregnant Hispanic women who have antibodies to toxoplasmosis, a chronic infection caused by a parasite affecting more than 40 million people in the United States. A third of the women who tested positive for the infection experience adverse prenatal events, such as miscarriage or preterm birth. Groer is writing an NIH grant to fund further research on the topic, and said “it would be of interest to determine both gut and placental microbiome in this population’’ of women.

– Story by Kurt Loft

National Science Foundation research by USF Health’s Larry Dishaw has relevance for debilitating digestive disorders like inflammatory bowel disease

What can we learn about human health from the lowly sea squirt?

More than you may think.

In his laboratory at the USF Children’s Research Institute in St. Petersburg, microbiologist Larry Dishaw, PhD, uses the sea squirt known as Ciona intestinalis to study how the innate immune system interacts with microbes that settle in the gut in ways that seem to facilitate homeostasis (stability) and promote survival and health.

Supported by a four-year, $867,581 grant from the National Science Foundation (NSF), Dr. Dishaw’s immune research explores the populations of microbes living together in the gut – trillions of bacteria, viruses, fungi and even some parasites – collectively known as the gut microbiome. His team is also interested in defining how disruption of a stable gut microbiome relates to the onset of inflammatory bowel disease, an autoimmune disorder affecting 1.6 million Americans.

Microbiologist Larry Dishaw, PhD, associate professor of pediatrics at the USF Health Morsani College of Medicine

“Many factors are at play in regulating the microbiome,” said Dr. Dishaw, an associate professor of pediatrics at USF Health Morsani College of Medicine. “And a lot of researchers around the world are interested in how the microbiome colonizes in animals, how this microbial community achieves stability, how it can shift out of balance, and how it is relevant to protecting human health.”

One of closest evolutionary invertebrate relatives of humans

Ciona intestinalis, an invertebrate marine animal resembling a spongy plant, spends its life attached to underwater structures like boat hulls and pier pilings where it continually siphons in water through one end, filtering out plankton and algae to eat and then squirting water and waste out the other end.

If you look under the microscope at the translucent juvenile sea squirts cultivated by Dr. Dishaw’s lab you can see a gut (with a stomach and intestinal compartment) similar to the digestive tract of vertebrates.  Despite its primitive appearance, the sea creature – a protochordate — is considered one of the closest evolutionary invertebrate relatives of humans.

Unlike humans, sea squirts rely their entire lives solely on naturally present innate immunity for host defense. They lack the other more evolved arm of immunity know as adaptive immunity, which differs from one animal species to the next and activates in response to specific foreign invaders.

The adult sea squirt Ciona intestinalis

That, Dr. Dishaw says, is what helps make the sea creature a good model for investigating the evolution of the host immune system and its role in creating and maintaining a well-balanced gut microbiome.

“When humans are born, they do not develop adaptive immunity until ages 3 to 5… so the initial process of colonizing bacteria and other microbes that make up their microbiomes is all mediated by innate immunity,” he said.

With a simpler model system like the sea squirt, the researchers can look at innate immunity in isolation. They can monitor how the immune system responds when encountering microbes for the first time, how microbes initially “choose” where to colonize in the gut, and how the animal maintains homeostasis – that is, a healthy balance of gut microbes needed to digest food and absorb nutrients throughout its life.

Ultimately, the not-so-lowly sea squirt may provide better insight into gut defense evolution and define ways that beneficial (non-pathogenic) bacteria may help prevent the overgrowth of disease-causing (pathogenic) bacteria.

Tipping the “good” microbe – “bad” microbe balance

Dr. Dishaw’s NSF grant builds upon the work of his mentor Gary Litman, PhD, USF professor emeritus of pediatrics, whose lab discovered the genes for a family of variable region-containing chitin-binding proteins, or VCBPs, made and secreted by the gut wall in a different protochordate, the ancient fish-like organism amphioxus. These immune proteins appear to help regulate how bacteria and fungi interact and grow such that intestinal barrier function is enhanced, Dr. Dishaw said. The VCBPs also seem to influence the production or release of phages, viruses that infect and destroy specific gut bacteria, he added.

Dr. Dishaw with some laboratory team members. From left: Michael Schepps, undergraduate research assistant; Zachary Graham, lab technician; and Julie Voelschow, undergraduate research assistant. Not pictured are Ojas Natarajan, PhD, postdoctoral scientist; and Celine Atkinson, graduate student.

“The goal of our project is to find out what happens when we muck with that system. When the VCBPs don’t bind fungi or bacteria correctly, how is the physiological fitness of the animal affected?” Dr. Dishaw said. “We believe these immune effectors can shape the ecology of the gut microbiome in ways that promote (or deter) health. And we think the sea squirt model can help us understand how that happens.”

The researchers can rear germ-free juvenile Ciona, then introduce into their water whatever microbes they choose. Because the sea squirt filters water constantly, they can quickly track where in this controlled environment the newly introduced gut microbe populations settle and thrive as well as examine the role host-microbe interactions play in developing a frontline immune defense system.

In a series of experiments published last year in Open Biology, the USF researchers induced colitis-like inflammation and damage in sea squirts by exposing their guts to the chemical dextran sulfate sodium (DSS). They showed that DSS altered the production and settlement of the secreted immune molecule that binds bacteria.

The laboratory grows its own algae, cultured in beakers shown on the windowsill, to feed to the juvenile sea squirts.

Most invertebrates, including sea squirts, defend their gut walls against potential microbial attack and prevent infection with mucous rich in chitin. The researchers found that pretreatment with microparticles of chitin, a fibrous substance prevalent in Ciona’s epithelium-associated gut mucous, protected the animal from the colitis-like effects of subsequent DSS exposure.

Ciona, which permits the study of innate immunity in isolation, “may help us determine how innate immunity modulates recovery from colitis and the re-establishment of (gut microbiome) homeostasis,” the study authors concluded.

Promising power of phages to treat drug-resistant infections

Dr. Dishaw is also co-investigator for a National Institutes of Health grant led by the USF College of Nursing’s Maureen Groer, PhD. The project is investigating the link between the gut microbiome of premature infants and their health as they age.

Lab tech Zachary Graham and Dr. Dishaw look over culture plates of bacterial biofilms stained with crystal violet. The bacteria were recovered from the gut of the sea squirts.

“We think early colonization of microbes is critically important in establishing lifelong gut microbiome features,” Dr. Dishaw said. “So, early life events that shape the (evolving) microbiome — like spending 4 to 6 weeks in a neonatal intensive care unit where the infant receives multiple antibiotics to treat or prevent infections — could translate into long-term changes in health.”

The ultimate goal of microbiome research is to come up with effective treatments to reset the equilibrium of a microbial community gone awry – whether by diet, stress, pathogens, or even the medications used to fight disease.

Fecal microbiota transplants, which insert a healthy donor’s fecal matter into a recipient’s colon to reconstitute a stable gut microbiome, have already become a relatively common treatment for Clostridium difficile (C. diff) infection, a debilitating gastrointestinal disease resistant to many antibiotics.

The crystal violet-stained cultures allow researchers to estimate the amount of biofilm formed during stationary growth of the bacteria.

In an age of growing multidrug resistance, Dr. Dishaw believes that phage therapy also offers promise as an alternative or supplement to antibiotics for patients suffering from recurrent, difficult-to-treat infections.  In another NSF grant with co-principal investigator Mya Breitbart of the USF College of Marine Sciences, he is colonizing a variety of bacteria in the sea squirts in an effort to test how phages – the viruses that infect bacteria – can be used to selectively eliminate harmful gut bacteria.

Phages, which specifically target single types of bacteria, might be harnessed to chase pathogens out of the microbial community without having to rely on antibiotics, which can wipe out both harmful and beneficial bacteria, Dr. Dishaw said. “In theory, you could use a C diff phage with high precision to target and kill only C. diff bacteria.”

Dr. Dishaw also participates in a clinical study with the USF Health Department of Pediatrics and Johns Hopkins All Children’s Hospital to characterize the gut microbiomes of patients with primary immune deficiencies.  The research may provide a better understanding of how different aspects of immunity regulate the gut microbiome.

Microscopic image of a juvenile sea squirt shows its gut colonized by fluorescently labeled bacteria

-Video and photos by Torie Doll, USF Health Communications and Marketing

Dr. Maureen Groer heads a group of USF Health researchers in a five-year study examining the relationship between a common parasite and how it affects the brain of pregnant Hispanic women

Tampa, FL (August 31, 2017) – The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) has awarded more than $2.6 million to the University of South Florida College of Nursing to study the correlation between pregnant Hispanic women, depression and a common parasite that affects the brain.

Maureen Groer, PhD, Gordon Keller professor at the USF College of Nursing, will lead a group of USF Health researchers in a five-year study examining whether Hispanic women, who carry the Toxoplasma gondii parasite, have a greater risk of the infection reactivating during pregnancy.

The project is significant because it is the largest study ever done on Hispanic women infected with the parasite. The Toxoplasma parasite is a common organism that can be transferred through eating undercooked meat or touching cat feces.

The study could help pinpoint one of the causes of prenatal and postpartum depression and lead to different treatments for chronic toxoplasmosis.

Maureen Groer, PhD

Pregnant women, who have a weaker immune system, are more susceptible to the infection, which can cause brain and eye damage and result in personality changes. Once infected, the parasite normally lives in the brain in a dormant state.

“It would be the first large study to measure the immune changes in pregnancy and its effects on chronically infected women,” Dr. Groer said. “So we’re looking at immunity in these women across pregnancy.”

Dr. Groer and her team will screen more than 800 women at Tampa General Hospital’s Genesis Women’s Center to find 480 pregnant Hispanic women — half of the women will have tested positive for the parasite, while the remaining 240 women will not.

Researchers will monitor the two groups during pregnancy and for six weeks after giving birth. The women will undergo blood tests to study chemicals related to depression and eye exams to see if the parasite has formed cysts in the retina.  Scientists will also test the infant’s cord blood to see if the parasite was transferred from the mother.

Dr. Groer believes the women who carry the organism will be more likely to experience prenatal and postpartum depression and have the latent parasite reactivate during pregnancy.

“They had it already, and now their immune system is very different. And some defenses they normally had against the organism might be less effective. So if the organism reactivates, it will reactivate likely in the eye,” she said.

The study, titled “Chronic Toxoplasma gondii, Pregnancy Reactivation, and Perinatal Depression,” focuses on Hispanic women, because a previous USF health study Dr. Groer conducted linking depression and the Toxoplasma gondii parasite noticed a high infection rate among Hispanic women.

Dr. Groer will work with a team of USF Health researchers who specialize in ophthalmology, biological chemistry, molecular medicine, psychiatry, neurosciences, and biostatistics.

The study’s co-investigators within the College of Nursing include Allyson Duffy, PhD, assistant professor; Amanda Elliott, PhD, assistant professor; and Ming Ji, PhD, professor.

Dr. Groer will also collaborate with researchers and physicians from USF Health Morsani College of Medicine, including Andreas Seyfang, PhD, associate professor; Jamie Fernandez, MD, associate professor; Steven Cohen, MD, professor; Karen Bruder, MD, associate professor; and Adetola Louis-Jacques, MD, assistant professor.

Teodor Postolache, MD, a psychiatry professor at the University of Maryland School of Medicine, will also be a co-investigator. Dietmar Fuchs, an associate professor of biological chemistry at Innsbruck Medical University in Austria, will consult on the project.

The study is supported by NICHD, part of the National Institutes of Health (NIH). NICHD strives to ensure that every child is born healthy and grows up free from disease and disability. For more information about NIH and NICHD visit www.nichd.nih.gov.

-Story by Elizabeth Brown,  USF College of Nursing Communications

From molecular discoveries to health policy applications, Drs. Maureen Groer and William Sappenfield have built impressive careers working to improve perinatal care.

Many parents may never understand how the health of their children begins long before birth, but USF Health’s Maureen Groer, PhD, and William Sappenfield, MD, MPH, are both passionate about translating research into better health care and outcomes for mothers and babies.

Dr. Groer, who holds a PhD in physiology, is a pediatric nurse, family nurse practitioner and the Gordon Keller Professor at the USF College of Nursing. She works primarily at the micro level – examining the molecular mechanisms underlying immunology, biology and behavior and how the “crosstalk” among these systems may affect the health of infants and their mothers.

USF College of Nursing’s Maureen Groer, RN, PhD, FAAN, a nurse physiologist with more than 35 years experience, studies underlying biobehavioral mechanisms affecting the health of infants and their mothers.

Dr. Sappenfield, a pediatrician and epidemiologist, is professor and chair of Community and Family Health at the USF College of Public Health, director of the Lawton and Rhea Chiles Center for Healthy Mothers and Babies, and co-director of the Florida Perinatal Quality Collaborative.   He works at the macro level – joining a variety of stakeholders to distill population data about diseases and their risk factors, treatment patterns and socioeconomic conditions into meaningful policies and practices to improve the health of mothers and babies.

USF College of Public Health’s William Sappenfield, MD, MPH, is a pediatrician and epidemiologist working with stakeholders at the local, state and national levels to improve the quality of perinatal care.

Linking the gut microbiome of premature infants with long-term health

The beneficial balance of trillions of bacteria, viruses and other microorganisms in the digestive tract – known as the gut microbiome – has become a hot research topic. Dr. Groer is particularly interested in the link between the gut microbiome in premature babies and their long-term health. Increasing evidence shows that the interaction of microbe populations and controlled inflammation in the gut plays a critical role in developing a healthy immune system. Other studies point to a gut-brain microbe connection with neuropsychiatric illnesses, such as autism, and attention deficit hyperactivity disorder.

In full-term healthy infants a “signature” gut microbiome – influenced by diet, where someone lives and other environmental determinants — is typically established by age 3.  But when infants are born too early, the proper evolution of the gut may be disrupted by various factors, including delivery by Cesarean section (C-section), physiological immaturity of the baby’s organs, and extended time in the neonatal intensive care unit (NICU).

While the NICU provides lifesaving supportive care, babies who spend their first weeks or months there, instead of living at home, receive multiple antibiotics, undergo stressful invasive procedures, interact less with their mothers, and typically ingest more formula milk than breast milk, which would transfer the mother’s own beneficial gut bacteria to the lactating infant.

The USF College of Nursing Biobehavioral Laboratory that Dr. Groer oversees is one of the top wet labs for nursing science in the country.

The National Institute of Nursing Research recently awarded Dr. Groer a $2.7 million, five-year grant to study how DNA extracted from the gut microbiome of preterm infants may be influencing their growth and development. The discoveries by USF and others may ultimately help devise ways to modify the mix of bugs in the premature baby’s gut to create the best microbiome possible for long-term physical and mental health.

“We don’t yet have the science to develop tailored probiotic treatments, but I think that’s the future,” Dr. Groer said. “This research might lead to early diagnosis and treatment of chronic bowel diseases, ways to reduce allergies and autoimmune diseases, and even new ways of preventing depression and anxiety.”

Dr. Groer with Adetola Louis Jacques, MD, a maternal-fetal medicine fellow in the Department of Obstetrics and Gynecology, collaborate on data for a manuscript. Dr. Groer works with researchers across several disciplines.

Continuously funded by the National Institutes of Health for the last 15 years, Dr. Groer works with colleagues in nursing, medicine, anthropology, developmental psychology, microbiology and other disciplines. Her work has contributed to a better understanding of the biobehavioral mechanisms underlying mother-infant interactions, including the growing body of evidence about the extensive health benefits of breastfeeding.

“To attract the kind of research funding we need to launch and support big studies, nurses need to understand metabolism, genomics, microbiomics and proteomics,” Dr. Groer said. We need this type of data-driven laboratory environment to contribute to the next generation of science, which is molecular.”

Using the power of meaningful data to help transform perinatal care quality

Even though he is a board-certified pediatrician, Dr. Sappenfield decided to embark on a career of public health research and practice instead of entering a traditional medical practice following his residency. He earned a master’s of public health degree from Harvard and completed postdoctoral training in preventive medicine and applied epidemiology at the Centers for Disease Control and Prevention (CDC).

“I fell in love with public health, because it was a way I could impact the health of children and families on a population basis, not just one child at a time,” Dr. Sappenfield said. “Knowing I can work with others to make a true measurable difference in lives of mothers, children and families gives me all energy I need to get up every day and go again.”

Dr. Sappenfield outside the Lawton and Rhea Chiles Center for Healthy Mothers and Babies, which he directs. The statewide center is based at the USF College of Public Health.

One of Dr. Sappenfield’s key academic achievements to help transform quality of care for pregnant women and newborns has been co-founding and co-directing the Florida Perinatal Quality Collaborative (FPQC) with John Curran, MD, professor of pediatrics and an associate vice president at USF Health.

The FPQC provides leadership and technical assistance to public and private partners across the state, often joining perinatal quality collaboratives in other states to launch health care quality improvement initiatives. Physicians, nurse midwives, nurses, public health professionals, hospitals, advocates, policy makers and payers voluntarily and collectively work together on select evidence-based initiatives to make measurable improvements in Florida’s maternal and infant health outcomes.

“Most of the initiatives we’re funded to do at $100,000 to $200,000 per year have been saving millions of dollars in costs while also improving health care and the quality of lives of mothers and babies,” Dr. Sappenfield said.

For example, one of FPQC’s first successes was its participation in a March of Dimes-supported, multistate pilot project to reduce escalating rates of early elective deliveries – inductions of labor and C-sections without a medical reason before a baby reaches a full 39 weeks gestational age.  Babies delivered before full term are at higher risk for serious complications, including respiratory distress, brain injuries, learning disabilities, and breastfeeding problems.

Dr. Sappenfield works with colleagues at the Chiles Center.

A recent demonstration project to reduce potentially deadly central-line associated infections in newborns saved an estimated $8 million over 18 months by avoiding infections, reducing hospital stays, and preventing deaths, Dr. Sappenfield said. Using hospital-specific data monitoring and hands-on training, the FPQC helped 18 Florida NICUs establish practices proven to reduce infection, including rigorous catheter insertion protocols and techniques for maintaining a sterile environment.

A new project to start in September focuses on improving the use of antenatal steroids, medications shown to safely reduce complications for premature babies when given at the optimal time to women at high risk for preterm deliveries. A second initiative expected to launch in November targets hypertension (high blood pressure) during pregnancy, one of the leading causes of pregnancy-related illnesses and deaths in Florida.

“With quality improvement, we’re trying to take what we’ve learned (works) from research and put into place systems and practices to make sure everyone gets those benefits,” Dr. Sappenfield said.

Dr. Sappenfield, a pioneer in applying epidemiology to issues affecting maternal and child health, has worked in the field for more than 30 years. “There’s never been a more exciting time than now,” he says.

Dr. Sappenfield is optimistic about the potential to make even greater advances in maternal and child health.

“I’ve been working to try to improve the health of mothers and babies for 30 years, and there’s never been a more exciting time than now,” he said. “Everyone is willing to work together to make a difference in the lives of these mothers and babies.”

Photos and video by Sandra Roa, USF Health Communications

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Dr. Maureen Groer leads a group of USF Health researchers in a five-year study examining the connection between digestive tract microbes and health and development

Tampa, FL (June 18, 2015) –The National Institute of Nursing Research (NINR) has awarded more than $2.7 million to University of South Florida College of Nursing to study preterm infants’ gut microbiome and its effect on their growth and development.

Maureen Groer, PhD, Gordon Keller professor at USF College of Nursing, will lead a team of USF Health researchers to study “The preterm infant microbiome: Biological, behavioral and health outcomes at two and four years of age.” During this five-year research project, Dr. Groer and her team will study 100 low birth weight infants through age 4.

The microbiome is the DNA extracted from the population of bacteria and other microorganisms living in the human gut.

Maureen Groer, PhD, Gordon Keller professor at USF College of Nursing, is principal investigator of the study analyzing stool samples over time to test for any links between microbes in the digestive tract and preterm infants’ growth and health outcomes.

The USF study will help measure and evaluate the preterm babies’ development, health and growth over time to discover if there is a direct relationship to the gut microbiome. The researchers will analyze preterm babies’ stool samples, collected for a previous NIH-funded study on feeding and health outcomes led by Dr. Groer. That earlier study examined stool samples obtained over the infants’ six-week stays in the neonatal intensive care unit (NICU). For the new study, researchers will collect more samples from these same infants at ages 2 and 4.

“The gut microbiome is in most cases established at three years old – except in those who may have an abnormal gut microbiome,” Dr. Groer said. “Previous research shows that the gut microbiome has a direct relationship with brain neurochemistry, behavior, metabolism and the development of the immune system. So, there is a variety of behavior, allergic and autoimmune diseases including Crohn’s disease, autism, diarrhea and obesity that may be related to disruption of the gut microbiome.”

Dr. Groer will conduct the study with a leading team of USF Health researchers including Terri Ashmeade, MD, associate professor at the USF Health Morsani College of Medicine’s Department of Pediatrics and NICU director at Tampa General Hospital; Larry Dishaw, PhD, assistant professor at USF Pediatrics; Ming Ji, PhD, professor at USF Nursing; Kathleen Armstrong, PhD, professor at USF Pediatrics; and Elizabeth Miller, PhD, assistant professor at the USF Department of Anthropology.

The children’s microbiome samples will be measured at the Argonne National Laboratory (ANL) by Jack Gilbert, PhD, associate professor and environmental microbiologist at the ANL Department of Ecology and Evolution. Maternal stool samples will be analyzed in the USF College of Nursing’s state-of the-art bio-behavioral laboratory.

The latest NIH study will be conducted by a multidisciplinary team of USF researchers from across nursing, medicine and anthropology.

According to Center for Disease Control and Prevention, preterm births affect one out of nine infants born in the United States. Preterm births are the number one cause of death in infants and the leading cause of long-term neurological disabilities and developmental health problems in children.

“We’re excited to lead the way in this research,” said Dianne Morrison-Beedy, PhD, senior associate vice president of USF Health and dean of the College of Nursing. “I’m proud to be part of a college that conducts research that makes life better for people locally, regionally and nationally.”

The study is supported by NINR, part of National Institute of Health (NIH). NINR helps promote and improve the health of individuals, families and communities. NINR is part of NIH’s 27 institutes and centers that support and conduct clinical and basic science research on health and illness. For more information about NIH and NINR visit www.ninr.nih.gov. 

-USF Health-
USF Health’s mission is to envision and implement the future of health. It is the partnership of the USF Health Morsani College of Medicine, the College of Nursing, the College of Public Health, the College of Pharmacy, the School of Biomedical Sciences and the School of Physical Therapy and Rehabilitation Sciences; and the USF Physician’s Group. The University of South Florida is a global research university ranked 50^th in the nation by the National Science Foundation for both federal and total research expenditures among all U.S. universities. For more information, visit www.health.usf.edu.

Media Contact:
Vjollca “V” Hysenlika, College of Nursing Communications
(813) 974-2017, or vhysenli@health.usf.edu

The NIA-funded study focuses on those who care for people with dementia and Alzheimer’s disease at home

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Tampa, FL (July 9, 2013) – The University of South Florida College of Nursing is conducting research to improve sleep in those caring for people with dementia and Alzheimer’s disease, with the aim of determining if better sleep affects heart health. The $1.9-million, four-year study funded by National Institute on Aging (NIA), “Improving Dementia Caregiver Sleep and the Effect on Heart Disease Biomarkers,” is led by USF College of Nursing Professor and Endowed Chair Meredeth Rowe, RN, PhD, FGSA, FAAN.

Fifteen million Americans provided an estimated 17.5 billion hours of unpaid care to people with Alzheimer’s disease and other dementias in 2012, according to the Alzheimer’s Association. Recent studies indicate that caregivers, unpaid family members or friends who assist people with Alzheimer’s with daily activities, may experience sleep loss from the constant demands of caregiving.

The College of Nursing study tests the relationship between caregiver sleep and heart disease to help understand what negatively affects caregiver health.

USF College of Nursing’s Dr. Meredeth Rowe places one of the monitoring device’s sensors beneath the mattress. The sensor detects movement and sounds an alarm to alert the caregiver if the person with Alzheimer’s disease starts to get out of bed.

“Caregiving and lack of sleep each separately increase the risk of heart disease,” Dr. Rowe said. “We want to discover whether improving sleep in caregivers lowers that risk.”

According to the 2006 Institute of Medicine (IOM) report “Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem,” the cumulative effects of sleep loss and sleep disorders have been associated with a wide range of adverse health consequences including increased risk of hypertension, diabetes, obesity, depression, heart attack, and stroke.

“The College of Nursing at the University of South Florida is transforming lives through research to improve the health of patients and their caregivers,” said Dianne Morrison-Beedy, PhD, RN, WHNP-BC, FNAP, FAANP, FAAN, senior associate vice president of USF Health and dean of the College of Nursing. “We’re making life better by transforming the health care of the family members who provide essential home care for persons with dementia. These caregivers fill an often unrecognized role in the healthcare system.”

The primary focus of Dr. Rowe’s research is finding an effective and easy-to-use treatment that can improve sleep in Alzheimer’s caregivers to increase their overall health and reduce the nursing home placement of people with dementia.

“When I was working on ways to provide caregivers better quality of sleep, I looked for technologies that might help and there were none,” Dr. Rowe said. “I realized that unless I invented a system that allowed them to sleep well, I was never going to have an impact on improving their sleep.”

Dr. Rowe explains to a caregiver how the integrated nighttime monitoring system tracks the bed occupancy and movement patterns around the house of a loved one with dementia. The goal is to allow the caregiver to rest easier through the night while maintaining the safety of the person with dementia.

A number of sensors can be placed around the house, including doorways, to analyze movement patterns and provide customized, specific alerts.

CareAlert, a new night monitoring system designed by Dr. Rowe and Caregiver Watch, LLC, provides reliable alerts to caregivers whenever a person with dementia leaves the bed and wanders through the house. The system helps the caregiver rest easier through the night, and improves the overall safety of the person with dementia. The findings of a study testing the effectiveness of CareAlert were published by Dr. Rowe and colleagues in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, in 2009. The researchers reported that use of CareAlert reduced nighttime injuries and unattended home exits by 85 percent over a period of 12 months.

“Dr. Rowe’s research seeks not only to improve caregiver sleep, but also to better understand the relationships between sleep and changes in heart health,” said Cindy L. Munro, PhD, RN, ANP-BC, FAAN, professor and associate dean for research and innovation at the USF College of Nursing.

In the latest research, Dr. Rowe is evaluating whether a combined intervention using  CareAlert and cognitive-behavioral therapy for insomnia improves sleep in individuals who care for people with dementia and Alzheimer’s who wake up at night. The study, conducted in the USF College of Nursing Caregiving Laboratory, will include as many as 100 participants. All will receive the CareAlert device and one of two sleep therapies assigned at random.

Dr. Rowe, a national expert in caregiver-related issues, worked with a company to design an evidence-based monitoring system with technology responsive to caregiver needs.

Rita F. D’Aoust, PhD, ACNP, ANP-BC, CNE, FAANP, FNAP, associate professor and associate dean of academic affairs and interprofessional initiatives at the USF College of Nursing, and Maureen E. Groer, RN, PhD, FAAN, Gordon Keller professor, are study co-investigators. Dr. D’Aoust studies the associations between vigilance and sympathetic nervous system activity, and Dr. Groer leads the design and analysis of biologic markers for heart disease. Others contributing to this research project include Brandi Mallek, research project manager; Taujihana Brown, research assistant; Glenna Brewster, predoctoral fellow; Milora Morley, undergraduate public health honors student.

The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the nation’s medical research agency and the leading supporter of biomedical research in the world. NIA, one of the 27 institutes and centers at NIH, helps understand the nature of aging and supports the health and well-being of older adults. Dr. Rowe has received many NIH grants throughout her research career to study people with Alzheimer’s disease or dementia and their caregivers. The USF College of Nursing ranks first in Florida and 24th in the nation in NIH funding, for both public and private schools of nursing.

Dr. Maureen Groer, a co-investigator for the caregiver sleep and heart disease risk study, watches as research lab technician Nicole Williams drops processed blood into a machine that will identify biomarkers of heart disease.

Dr. Rowe is currently enrolling participants for this study. For more information, contact USF College of Nursing Research Project Manager Brandi Mallek, at (813) 974-1827 or bmallek@health.usf.edu.

USF Health-

USF Health’s mission is to envision and implement the future of health. It is the partnership of the USF Health Morsani College of Medicine, the College of Nursing, the College of Public Health, the College of Pharmacy, the School of Biomedical Sciences and the School of Physical Therapy and Rehabilitation Sciences; and the USF Physician’s Group. The University of South Florida is a global research university ranked 50^th in the nation by the National Science Foundation for both federal and total research expenditures among all U.S. universities. For more information, visit www.health.usf.edu.

Media contact:
Ashlea Bailey, College of Nursing Communications 
(813)396-9642 or  ahudak@health.usf.edu

All photos with Dr. Rowe taken at the USF Health Byrd Alzheimer’s Institute’s Center for Memory C.A.R.E  by Eric Younghans, USF Health Communications
Video by Andy Faza, USF College of Nursing Communications & Marketing