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Community Health and Neuropathy: Nutritional and Environmental Links in Zambia (CHANNELZ)

社区健康和神经病：赞比亚的营养和环境联系 (CHANNELZ)

基本信息

批准号：
10360583
负责人：
Michelle Powell Kvalsund
金额：
$ 16.76万
依托单位：
UNIVERSITY OF ROCHESTER
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-08-05 至 2025-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10360583
关键词：
Adult Africa South of the Sahara Age Area Clinic Clinical Clinical Trials Communicable Diseases Communities Community Health Complex Data Development Diabetes Mellitus Diagnostic Dietary Factors Dietary Intervention Dietary intake Distal Environment Epidemiologic Methods Etiology Factor Analysis Folic Acid Folic Acid Deficiency Food Foot Ulcer Foundations Functional disorder Future Gender Goals HIV HIV Seronegativity Health Policy Health care facility Healthcare Homocysteine Household Individual Intervention Intervention Studies Knowledge Lead Link Maize Malnutrition Manihot Manuscripts Mentorship Metabolic Methodology Micronutrients Modeling Morbidity - disease rate Nature Neurologic Neurologist Neuropathy Nutritional Observational Study Outcome Assessment Pathogenicity Patient Care Pattern Peer Review Persons Phenotype Plasma Polyneuropathy Population Population Analysis Pragmatic clinical trial Predisposition Prevalence Province Quality of life Recurrence Research Research Training Risk Risk Factors Rural Sampling Scientific Advances and Accomplishments Structure Surveys Thiamine Thiamine Deficiency Time Validation Vitamin B 12 Vitamin B 12 Deficiency Zambia axonopathy base case control chronic pain comorbidity comparative design dietary experience falls food insecurity global health health care settings improved limb amputation member micronutrient deficiency neurotoxic nutrient deprivation nutrition population based public health intervention regional difference rural residence screening sex skills

项目摘要

Project Summary/Abstract The overarching goals of this project are to advance knowledge of the complex pathophysiology of distal symmetric polyneuropathies (DSP) and frame future interventions for nutritional neuropathies in Zambia through: 1) assessment of population-based estimates and risk factors for DSP in Zambia’s maize and cassava staple food zones; 2) comparison of population-based estimates and risk factors to previous clinic- based data from the same maize-staple districts; 3) and assessing the odds of specific micronutrient deficiencies among DSP cases and age, gender, and HIV-matched controls from the same districts. To accomplish these goals, Dr. Kvalsund will focus on acquisition of additional expertise and experience in the following key areas: 1) advanced epidemiological methods and analysis; 2) clinical trials methodologies, 3) global health policy; 4) neuropathy outcome assessments; and 5) HIV and nutrition. The needed skills will be achieved through structured mentorship, coursework, and pragmatic clinical trials and health policy experiences. The research-training plan will provide Dr. Kvalsund with the additional proficiency necessary to undertake future intervention research aimed at reducing nutrition-associated neurologic morbidity in Zambia and advancing scientific knowledge of the pathophysiologic mechanisms that generate DSP as a common phenotype. The central hypothesis is that the high rate of DSP previously observed in clinic populations in Zambia is equally prevalent outside healthcare settings owing to common endemic infectious diseases and their neurotoxic treatments, food insecurity and low dietary diversity, recurrent nutritional challenges, specific micronutrient deficiencies and their interactions, and possibly other unidentified latent factors. We hypothesize that folate-deficiency will be highly associated with DSP in Zambian communities, as has been documented in clinic populations, and may warrant a targeted public health intervention given the preventable nature and range of other neurologic morbidities also associated with folate deficiencies. The specific aims are to: 1) Determine population-based DSP estimates in Zambia; 2) Compare and contrast DSP estimates and risk factors with those from clinical settings in Zambia; 3) to consider the relative contributions of urbanicity, agroecological/staple food zone, and specific micronutrient deficiencies on DSP prevalence; and 4) Evaluate for latent environmental or toxico-dietary factors as contributors to DSP in this environment. The research is expected to provide the foundation for future R-01 intervention and observational research and to improve scientific understanding of how diverse etiologies, multiple exposures and interactions lead to a common clinicopathologic DSP phenotype, which remains poorly understood to date.

项目总结/文摘