Reducing stroke risk in African-American men

项目总结 美国成年人的中风负担是导致死亡的第五大原因，也是 残疾，估计耗资190亿美元。非洲裔美国人(AA)的中风发生率要高得多， 与其他任何种族群体相比。与白人相比，AA有更大的中风残疾，更多的后遗症 中风并发症，恢复较慢。中风预后的种族差异在以下人群中尤为严重 AA级的男人。不幸的是，只有有限的文献专门关注改善中风后的情况 照顾AA级男性中风幸存者。书面回应NIH PA-13-328：促进种族和 少数民族男性(R01)，拟议的项目将测试以课程为导向的自我管理支持 方法，有针对性的管理(团队)特别关注AA男性中风的高危人群。团队是一支 小组形式，护士和患者共同主导的干预，专注于患者和家庭的需求，在问题中实践- 解决问题，注重情绪和角色管理。该项目建立在来自2个有希望的试点数据的基础上 以前使用团队的R21项目。新的项目方面包括：1)关注AA男性，2)使用Peer 二人组(中风幸存者和他们的护理伙伴)作为关键的干预组成部分，3)使用课程驱动 自我管理，这在对AA男子的研究中很少使用，以及4)对机械性的调查 可能有助于解释团队最显著的实验元素的因素。 这个研究小组在具有里程碑意义的收缩压干预试验(Sprint)中所做的工作表明 集中努力将血压降低到适当的目标范围可以减少急性事件，如 中风，拟议的学习地点是一个理想的招聘环境，投资了关键人员，以及 支持性基础设施，对高风险AA男子的团队方法进行严格评估。这个 建议的项目是一项为期6个月的前瞻性随机对照试验，评估团队与等待的效果。 在过去5年内经历过中风或短暂性脑缺血发作的AA男性的列表(WL)控制。初级阶段 结果是收缩压改变，而次要结果包括舒张压、胆固醇、甘油三酯 糖尿病患者的血糖控制。探索性分析将评估假设的机械论 态度目标(中风知识、自我效能感、感受到的社会支持)以及 减少中风风险，包括饮食、锻炼、吸烟和烟草/物质使用。互补的质地 评估将评估团队和WL参与者的观点。如果试验结果可以得到确认， 团队代表了一种适合广泛扩展的实用方法，有可能扭转 由于中风，AA男性的发病率高得令人无法接受。

PROJECT SUMMARY The burden of stroke among US adults is the fifth leading cause of death and the leading cause of disability, costing an estimated $19 billion. African-Americans (AA) have substantially higher stroke rates, compared to any other racial-ethnic group. Compared to whites, AA have greater stroke disability, more post- stroke complications, and slower recovery. Racial disparities in stroke outcomes are particularly high among AA men. Unfortunately, there is only a limited literature that has specifically focused on improving post-stroke care for AA men stroke survivors. Written In response to NIH PA-13-328: Health Promotion among Racial and Ethnic Minority Males (R01), the proposed project will test a curriculum-guided self-management support approach, TargEted MAnageMent (TEAM) focused specifically on AA men at high risk for stroke. TEAM is a group-format, nurse and patient co-led intervention focused on patient and family needs, practice in problem- solving, and attention to emotional and role management. The project builds upon promising pilot data from 2 previous R21 projects using TEAM. Novel project aspects include the: 1) Focus on AA men, 2) Use of Peer Dyads (stroke survivors and their care partners) as a key intervention component, 3) Use of curriculum-driven self-management, which has rarely been used in studies of AA men, and 4) Investigation of mechanistic factors that may help explain the most salient experimental elements of TEAM. Work by this study team in the landmark Systolic Blood Pressure Intervention Trial (SPRINT) suggests that intensive efforts to reduce blood pressure (BP) to appropriate target ranges can reduce acute events like stroke, and that the proposed study site is an ideal recruitment environment with invested key personnel, and supportive infrastructure to conduct a rigorous evaluation of the TEAM approach in high-risk AA men. The proposed project is a 6-month prospective randomized controlled trial evaluating the effects of TEAM vs. wait- list (WL) control in AA men who have experienced a stroke or TIA within the past 5 years. The primary outcome is change in systolic BP, while secondary outcomes include diastolic BP, cholesterol, triglycerides and glycemic control for individuals with diabetes. An exploratory analysis will evaluate posited mechanistic attitudinal targets (stroke knowledge, self-efficacy, perceived social support) as well as proximal behaviors to reduce stroke risk including diet, exercise, smoking, and tobacco/substance use. A complementary qualitative assessment will evaluate the perspective of TEAM and WL participants. If pilot results can be confirmed, TEAM represents a practical approach suitable for broad scale-up, with the potential to reverse the unacceptably high morbidity seen in AA men due to stroke.