Asthma Disparities in Cohorts at Risk for Morbidity

有发病风险的人群中哮喘的差异

• 批准号: 6804612
• 负责人: JAMES R SHELLER
• 金额: $ 58.81万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-09-30 至 2007-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6804612
• 关键词: African American; Hispanic Americans; asthma; caucasian American; clinical research; clinical trials; cooperative study; data collection methodology /evaluation; disease /disorder proneness /risk; female; health care service utilization; health education; human data; human morbidity; human pregnant subject; longitudinal human study; low socioeconomic status; outcomes research; patient oriented research; pregnancy; pregnancy disorder; racial /ethnic difference; smoking cessation; urban area

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.

描述（由申请人提供）： 该中心的目标是确定哮喘差异的潜在机制，并改善哮喘特异性、孕产妇和围产期并发症高危目标人群（哮喘孕妇）的哮喘护理。拟议中的Meharry-Vanderbilt减少哮喘差异中心题为“有发病风险的人群中的哮喘差异”，这是在机构之间的正式联盟Meharry-Vanderbilt联盟的背景下产生的一项联合合作努力。该联盟承诺两个机构相互学习，以促进学生教育，患者护理和研究进展。该联盟已经建立了国家卫生研究院的资金，组织了社区外展活动，并使机构交叉培训正规化。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制定的，以优化少数民族服务机构梅哈里医学院和研究密集型机构范德比尔特大学的独特价值。基金专门用于医学生的夏季研究经验和与哮喘差异有关的试点调查。该提案针对的是面临哮喘相关发病风险的少数群体：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。一项针对两种文化敏感的哮喘教育和戒烟计划的相对有效性的对照随机试验将针对黑人或西班牙裔哮喘孕妇。与此同时，同一批研究人员将利用行政数据和生命记录来检查一大群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哮喘的方式似乎有所不同。因此，我们将召集参加急诊室的患者和家庭的焦点小组，以验证文化敏感的工具，以改善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测量相匹配，并与白人的估计进行比较。该方法将用于将假设扩展到该地区唯一的儿科ICU的重度哮喘儿童。在儿科ICU中，入院率和结局将与β 2肾上腺素能受体（BADR 2）的潜在重要遗传变异相关。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，解释严重哮喘中哮喘差异的遗传基础。这些相互关联的项目由来自每个机构的研究人员联合进行，将阐明哮喘差异的机制，并为有哮喘发病风险的目标少数群体提供新的干预措施。