Asthma Disparities in Cohorts at Risk for Morbidity

描述(由申请人提供)： 该中心的目标是确定导致哮喘差异的机制，并改善针对哮喘高危人群、母亲和围产期并发症、患有哮喘的孕妇的哮喘护理。拟议的梅哈里-范德比尔特减少哮喘差异中心，题为“发病率高危人群中的哮喘差异”，是在两个机构之间的正式联盟--梅哈里-范德比尔特联盟--的背景下产生的一项联合合作努力。这一联盟承诺两家机构相互学习，以造福于学生教育、患者护理和研究进展。该联盟已经建立了NIH基金，组织了社区外联活动，并正式开展了机构交叉培训。拟议的中心将是联盟目标和方法的自然延伸。这些培训项目是联合开发的，以优化少数族裔服务机构Meharry医学院和研究密集型机构Vanderbilt University的独特价值。专门为医科学生的暑期研究体验和与哮喘差异有关的试点调查提供资金。这项建议针对的是有严重哮喘相关疾病风险的少数群体：孕妇、需要重症监护病房(ICU)的儿童和需要紧急护理的哮喘患者。一项关于两种文化敏感型哮喘教育和戒烟计划相对有效性的对照随机试验将以患有黑人或西班牙裔种族/民族哮喘的孕妇为目标。与此同时，同样的调查人员将利用行政数据和生命记录检查一大批孕妇中与哮喘相关的发病率。与白人相比，黑人对哮喘严重程度的看法和描述方式似乎有所不同。因此，我们将召集急诊室的患者和家属的焦点小组，以验证一种文化敏感的工具，以改进黑人哮喘严重程度的描述。患者对哮喘严重程度的估计将与客观措施相匹配，并与白人的评估结果进行比较。然后，这一方法将被用来将假设扩展到严重哮喘入院的儿童=S仅限儿科ICU。在儿科ICU中，入院率和预后将与潜在的重要的β2肾上腺素能受体(BADR2)基因变异有关。使用父母和未受影响的兄弟姐妹作为病例对照，一种新的计算方法将测试基因-基因相互作用，这解释了严重哮喘中哮喘差异的遗传基础。这些由每个机构的研究人员联合开展的相互关联的项目将阐明导致哮喘差异的机制，并为有哮喘发病风险的目标少数群体提供新的干预措施。

DESCRIPTION (provided by applicant): The goals of this Center are to determine the mechanisms underlying the disparities in asthma, and to improve asthma care in a targeted group at high risk for asthma-specific, maternal and perinatal complications, pregnant women with asthma. The proposed Meharry-Vanderbilt Center for Reducing Asthma Disparities entitled Asthma Disparities in Cohorts at Risk for Morbidity@ is a joint collaborative effort produced in the context of a formal alliance between the institutions, the Meharry-Vanderbilt Alliance. This Alliance commits the two institutions to learn from each other for the benefit of student education, patient care, and research progress. The Alliance has already established NIH funding, organized community outreach, and formalized institutional cross training. The proposed Center would be a natural extension of Alliance goals and methods. The training projects were developed jointly to optimize the unique values of the minority serving institution, Meharry Medical College, and the research intensive institution, Vanderbilt University. Funds are dedicated for summer research experiences for medical students and for pilot investigations relevant to asthma disparities. This proposal targets minority groups at risk of significant asthma-related morbidity: pregnant women, children requiring intensive care unit (ICU) admission and asthmatics requiring emergency care. A controlled randomized trial of the relative efficacy of two culturally sensitive asthma education and smoking cessation programs will target pregnant women with asthma of black or Hispanic race/ethnicity. Simultaneously, the same investigators will examine asthma-related morbidity in a large cohort of pregnant women utilizing administrative data and vital records. Perceptions of asthma severity and ways to describe it appear to differ in Blacks compared to whites. Therefore we will convene focus groups of patients and families attending the emergency room to validate a culturally sensitive instrument to allow improved descriptors of asthma severity for Blacks. Estimates by the patients of asthma severity will be matched to objective measures, and compared with those of whites. This methodology will then be used to extend the hypothesis to children admitted with severe asthma to the region=s only pediatric ICU. In the pediatric ICU, the admission rates and outcomes will be associated with the potentially important genetic variations in the beta 2 adrenergic receptor (BADR2). Using parents and non-affected siblings as case controls, a novel computational method will test for gene-gene interactions that explain a genetic basis for asthma disparities in severe asthma. These interrelated projects jointly conducted by investigators from each institution will illuminate the mechanisms responsible for asthma disparities and provide novel interventions in targeted minority groups at risk for morbidity from asthma.