Factors Influencing Pediatric Asthma (FIPA)

哮喘可以作为多因素医疗条件的典型代表。的发病机制 是复杂的，与环境和心理社会因素的相互作用是众多的。少数群体和 弱势群体往往表现出哮喘患病率增加以及发病率和死亡率增加， 这一点还没有完全理解。这项提案将招募一个基于人口的美洲印第安人样本， 在SD Eagle Butte的夏延河苏族部落，120例明确定义的病例和240例匹配的对照， 对遗传、免疫、环境等广泛因素的横断面调查 暴露，教育能力，经济资源，获得和利用医疗保健， 生活质量另外，1/2的病例将被纳入强化教育的随机试验 与常规护理相比，与理解、自我指导护理和赋权有关。干预 将持续2年，并在3年时进行随访检查。分析将以“意图 治疗”的基础上，主要终点将是诊所和急诊室的呼吸投诉。是 预计终点的采集将非常完整，因为该社区几乎所有的临床护理都是 由印度卫生局或部落诊所提供，两者都将配合本研究。 该建议的一个重要组成部分是加强与以下方面有关的社区人力资源： 生物医学研究和临床护理。部落大学生将从事兼职（但积极） 研究团队的成员，招募和教育参与者，收集和分析数据， 将研究结果转化给社区成员和领导者，并希望他们对此更感兴趣， 健康问题，因为他们影响少数民族人口。尽管这个社区一直在接受和 过去参与遗传研究，该项目的这一组成部分将扩大这一经验， 当地部落大学的学生，也包括海龟山学院的学生，在那里进行基因分型。 另一个令人兴奋的方面是一个年轻的美国印第安人调查员和临床医生的参与， 达科塔扮演重要角色。

Asthma could serve as the poster child of multifactorial medical conditions. The pathogenetic mechanisms are complex and the interactions with environmental and psychosocial factors are numerous. Minority and disadvantaged groups often show increased prevalence of asthma and increased morbidity and mortality, which is not fully understood. This proposal will recruit a population-based sample of American Indians from the Cheyenne River Sioux Tribe at Eagle Butte, SD, 120 well-defined cases and 240 matched controls for a cross sectional investigation of a broad range of factors running from genetics, immunity, environmental exposures, educational ability, economic resources, access and utilization of medical care, to perceived quality of life. In addition, 1/2 ofthe cases will be recruited into a randomized trial of intensive education related to understanding, self-directed care and empowerment compared with usual care. The intervention will last for 2 years and a follow-up exam will be conducted at 3 years. Analysis will be on an "intention to treat" basis and the primary end point will be clinic and emergency room visits for respiratory complaints. It is anticipated that capture of endpoints will be very complete, as nearly all clinical care in this community is provided by the Indian Health Service or tribal clinics, both of which will cooperate with this study. An important component ofthis proposal is the enhancement of community human resources related to biomedical research and clinical care. Tribal college students will be engaged as part-time (but active) members ofthe research team, recruiting and educating participants, collecting and analyzing data, translating findings to community members and leaders, and hopefully becoming more interested and aware of health issues as they impact minority populations. Although this community has been accepting and involved in genetic research in the past, this component ofthe project will expand this experience, both for local tribal college students; but also for those at Turtle Mountain college, where genotyping is conducted. Another exciting aspect is the involvement of a young American Indian investigator and clinician from South Dakota in a prominent role.