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

在美国每年发生的70万中风中，超过四分之一是中风幸存者。 黑人，或非裔美国人，无论是在全国范围内还是在纽约的哈莱姆区，复发率都增加了两倍 中风，我们的数据显示，哈莱姆区的拉美裔人患中风的风险是白人的三倍。这个 中风复发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。 探员们。对于低收入的少数族裔人群来说，控制这些风险因素可能特别具有挑战性 他们往往缺乏所需的医疗保健、财政和社区支持，以坚持必要的和终生的 治疗。在哈莱姆区，72%的中风后6个月的成年人没有这三个风险因素 得到了充分的对待。同行主导的患者教育倡议可能有助于中风幸存者更好地管理他们的风险 各种因素。这些举措可能被证明是有效的、低成本的、可持续的中风预防战略 有色人种社区，其居民因中风而承受不成比例的痛苦负担。 在过去的十年里，我们一直在进行研究，以了解和减少健康差距 与哈莱姆区的中风及相关疾病有关。我们还与客户建立了牢固的关系 哈莱姆区的社区领袖，帮助我们制定适合文化的干预措施。我们的团队适应了 斯坦福慢性疾病自我管理计划，为患有所有慢性病的成年人开设的同行主导课程 以帮助急性中风幸存者降低复发风险。一项随机化的初步结果 用于测试其有效性的对照试验表明，干预对象的三种风险都增加了24% 与那些随机接受常规护理的患者相比，这些因素得到了控制。然而，样本量有限， 基于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、拉丁裔和白人社区居民 过去五年内曾中风或短暂性脑缺血发作的哈莱姆区居民。我们会 然后进行并严格评估一项随机对照试验，以确定参与该试验 该计划改善了对中风复发危险因素的控制。最后，如果审判成功，我们将 努力在当地维持该计划，在全国范围内传播结果，并利用所学到的经验教训 健康政策。

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.