Factors Influencing Pediatric Asthma (FIPA)

哮喘可以成为多因素疾病的典范。致病机制 是复杂的，与环境和心理社会因素的相互作用是多方面的。少数族裔和 弱势群体往往表现为哮喘患病率增加，发病率和死亡率增加， 这一点还没有完全被理解。这项提议将从美国印第安人中招募一个基于人口的样本 南卡罗来纳州伊格尔巴特的夏延河苏族部落，120例明确病例和240例配对对照 对遗传学、免疫力、环境等广泛因素的横断面调查 暴露、教育能力、经济资源、医疗保健的获得和利用 生活质量。此外，一半的病例将被招募到强化教育的随机试验中 与通常的护理相比，与理解、自我指导的护理和赋权有关。干预措施 将持续2年，并将在3年内进行后续考试。分析的重点将是“意向 治疗“的基础和主要终点将是呼吸疾病的诊所和急诊室就诊。它是 预计终端捕获将非常完整，因为该社区中的几乎所有临床护理都是 由印度卫生服务机构或部落诊所提供，这两个机构都将与本研究合作。 这项建议的一个重要组成部分是加强社区人力资源 生物医学研究和临床护理。部落大学生将作为兼职(但积极)参与。 研究团队成员，招募和教育参与者，收集和分析数据， 将调查结果翻译给社区成员和领导者，希望能变得更感兴趣和更有意识 在影响少数群体的情况下，对健康问题的认识。尽管这个社区已经接受了 过去参与基因研究，该项目的这一部分将扩大这一经验，两者都 当地部落大学生；也适用于海龟山学院的学生，那里进行了基因分型。 另一个令人兴奋的方面是一位来自南方的年轻美国印第安人研究员和临床医生的参与 达科他州在其中扮演着突出的角色。

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.