PRAISE: Preventing recurrence of all inner-city strokes through education;

在美国每年发生的70万中风中，有四分之一以上是中风幸存者。 黑人，或非洲裔美国人，无论是在全国范围内和在哈莱姆，纽约市，有两倍的增加， 中风，我们的数据显示，在哈莱姆的拉丁美洲人，有三倍的风险增加相对于白人。的 复发性卒中的主要危险因素包括高血压、高脂血症和抗血栓药物使用不足。 剂.控制这些风险因素对于低收入的少数民族人群来说可能特别具有挑战性 他们往往缺乏必要的医疗保健，财政和社区支持， 治疗在哈莱姆，72%的中风后六个月的成年人没有这三个危险因素 得到充分的对待。同行领导的患者教育计划可以帮助中风幸存者更好地管理他们的风险 因素这些举措可能被证明是有效的，低成本的，可持续的中风预防策略， 有色人种社区，其居民因中风而承受不成比例的痛苦负担。 在过去十年中，我们一直在进行研究，以了解和减少健康差距， 与哈莱姆的中风和相关疾病有关。我们还与以下方面建立了牢固的关系： 哈莱姆的社区领袖帮助我们制定文化上合适的干预措施。我们的团队 斯坦福大学慢性病自我管理项目，一个针对所有慢性病患者的同行领导课程。 疾病，帮助急性中风幸存者降低复发风险。一项随机研究的早期结果 一项测试其有效性的对照试验表明，24%以上的干预受试者同时存在这三种风险， 与随机分配到常规护理组的患者相比，然而，样本量有限， 根据我们的住院病人招募方法 我们的目标是与我们的社区合作伙伴合作，采用一种新颖的，基于社区的招聘策略， 他们求婚了通过这一战略，我们将确定600个黑人，拉丁美洲人和白色社区居住 哈莱姆的居民在过去的五年内中风或短暂性脑缺血发作。我们将 然后进行并严格评估一项随机对照试验，以确定是否参与这项研究， 该计划改善了对中风复发风险因素的控制。最后，如果试验成功，我们将 努力在当地维持该计划，在全国范围内传播结果，并利用学到的经验教训， 卫生政策。

More than one fourth of the 700,000 strokes that occur annually in the US are among stroke survivors. Blacks, or African Americans, both nationally and in Harlem, NYC, have a twofold increase in recurrent strokes, and our data reveal that Latinos in Harlem, have a threefold increase in risk relative to Whites. The primary risk factors for recurrent stroke include hypertension, hyperlipidemia, and underuse of antithrombotic agents. Controlling these risk factors may be particularly challenging for low-income, minority populations who often lack the healthcare, financial and community support needed to adhere to necessary and lifelong therapies. In Harlem, 72% of adults studied six months post- stroke did not have these three risk factors treated adequately. Peer-led patient education initiatives may help stroke survivors better manage their risk factors. Such initiatives may prove to be effective, low cost, sustainable stroke prevention strategies within communities of color, whose residents bear a disproportionate burden of suffering due to strokes. Over the past decade, we have been conducting studies to understand and reduce the health disparities related to stroke and associated conditions in Harlem. We have also built strong relationships with community leaders in Harlem that help us develop culturally appropriate interventions. Our team adapted the Stanford Chronic Disease Self-Management Program, a peer-led course for adults with all chronic diseases, to help acute stroke survivors reduce their risks for recurrence. Early results of a randomized controlled trial to test its effectiveness demonstrate that 24% more intervention subjects had all three risk factors controlled, compared with those randomized to usual care. However, the sample size was limited, based on our inpatient recruitment approach. We aim to work with our community partners to employ a novel, community based recruitment strategy that they proposed. Through this strategy, we will identify 600 Black, Latino and White community-dwelling residents of Harlem who have had strokes or transient ischemic attacks the past within five years. We will then conduct and rigorously evaluate a randomized, controlled trial to determine if participation in this program improves the control of risk factors for stroke recurrence. Finally, if the trial is successful, we will work to sustain the program locally, disseminate the results nationally, and use the lessons learned to inform health policy.