Reducing stroke risk in African-American men

项目摘要 美国成年人的中风负担是第五大死亡原因，也是第一大死亡原因。 残疾，估计耗资190亿美元。非裔美国人（AA）的中风率明显更高， 与其他种族相比。与白人相比，AA有更大的中风残疾， 中风并发症和恢复较慢中风结局的种族差异在以下人群中特别高： 戒酒会的人。不幸的是，只有有限的文献专门关注改善中风后 照顾AA男性中风幸存者。美国国立卫生研究院PA-13-328：种族和民族之间的健康促进 少数民族男性（R 01），拟议的项目将测试一个社区指导的自我管理支持 采用靶向MAnageMent（TEAM）方法，特别关注中风高危的AA男性。团队是一 小组形式，护士和病人共同领导的干预，重点是病人和家庭的需要，实践中的问题， 解决问题，注意情绪和角色管理。该项目建立在来自2000年的有希望的试点数据基础上。 以前的R21项目使用团队。新颖的项目方面包括：1）关注AA男性，2）使用同伴 二人组（卒中幸存者及其护理伙伴）作为关键干预成分，3）使用脑卒中驱动的 自我管理，很少用于AA男性的研究，和4）调查机制 这些因素可能有助于解释TEAM最突出的实验元素。 该研究小组在具有里程碑意义的收缩压干预试验（SPRINT）中的工作表明， 将血压（BP）降低到适当的目标范围可以减少急性事件， 中风，并且拟定的研究中心是一个理想的招募环境，有投入的关键人员，以及 支持性基础设施，以进行严格的评估TEAM方法在高风险AA男性。的 拟议的项目是一项为期6个月的前瞻性随机对照试验，评估TEAM与等待的效果， 列表（WL）控制AA男性谁经历了中风或TIA在过去5年。主 结果是收缩压的变化，而次要结果包括舒张压、胆固醇、甘油三酯 以及糖尿病患者的血糖控制。探索性分析将评估假设的机制 态度目标（中风知识、自我效能、感知的社会支持）以及最近的行为， 降低中风风险，包括饮食、锻炼、吸烟和烟草/物质使用。一个补充的定性 评估将评估团队和WL参与者的观点。如果试点结果能够得到确认， TEAM是一种适合广泛推广的实用方法，有可能扭转 在AA男性中由于中风而观察到的不可接受的高发病率。

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.