Reducing stroke burden in Uganda

 描述（由申请人提供）：中风是一种神经系统疾病，在许多低收入和中等收入国家的负担迅速增加。由于人口快速增长、寿命延长、工业化模式、采用有害的西方饮食以及高血压和肥胖等风险因素的流行，非洲受到中风负担的打击尤其严重。 尽管预测令人生畏，但中风通常是一种可预防的脑部疾病。早期识别和管理危险因素可以大大降低卒中负担。为响应PAR-14-331“终生全球脑和神经系统疾病”，拟议的项目将开发一种以人为中心的卒中负担减轻方法，该方法在乌干达实用有效，可推广到撒哈拉以南非洲的其他国家，并将为未来减轻卒中负担的努力发展研究能力。这项拟议的研究包括来自乌干达坎帕拉Makerere大学和美国俄亥俄州凯斯西储大学的研究人员，他们在以前的合作中有成功和建立的跟踪记录，包括NINDS资助的医学教育合作伙伴计划（MEPI），重点是神经系统疾病。 该项目将分为三个阶段/三个目标; 1.）对乌干达降低卒中风险的障碍和促进因素进行混合方法（定量+定性）评估; 2）制定手动自我管理方法（SMA），以降低具有多种风险因素的乌干达人的原发性和继发性卒中风险，以及3）。为建立临床试验基础设施、经过充分培训的工作人员和数据工具/程序奠定基础，为实施干预性卒中负担减轻试验做准备。在第1阶段/目标1中，研究人员将对440名个体进行流行病学调查，以更好地了解卒中知识和态度。将采用个人和小组形式的方法进行次级抽样定性评估。在第2阶段/目标2中，研究小组将采用最初为非洲裔美国人开发的成功SMA。在III期/目标3中，研究团队将选择适当的措施，培训工作人员实施措施，并最终确定SMA，以便使用护士和Peer Dyad（成功管理卒中风险因素的个人）进行分娩。最后，在培训/概念验证练习中，护士和同伴将对2个SMA目标进行SMA（一组最多8名有卒中风险的个体，一组最多8名卒中个体）。

 DESCRIPTION (provided by applicant): Stroke is a neurological condition with rapidly increasing burden in many low- and middle-income countries. Africa is particularly hard-hit by stroke burden due to rapid population growth, increased lifespan, patterns of industrialization, adoption of harmful western diets, and increased prevalence of risk factors such as hypertension and obesity. In spite of the daunting projections, stroke is often a preventable brain disorder. Early identification and management of risk factors can greatly reduce stroke burden. Written in response to PAR-14-331 "Global Brain and Nervous System Disorders Across the Lifespan", the proposed project will develop a person- centered stroke burden reduction approach that will be practical and effective in Uganda, generalizable to other countries in Sub-Saharan Africa, and will develop research capacity for future efforts in stroke burden reduction. The proposed study includes investigators from Makerere University in Kampala, Uganda, and from Case Western Reserve University, Ohio, U.S.A, who have a successful and established track-record of previous collaboration, including a NINDS-funded Medical Education Partnership Initiative (MEPI) focused on neurological conditions. This proposed 3-phase/3-aim project will; 1.) Conduct a mixed-methods (quantitative + qualitative) assessment of barriers and facilitators to stroke risk reduction in Uganda; 2) Develop a manualized self-management approach (SMA) to reduce primary and secondary stroke risk in Ugandans with multiple risk factors, and 3.) Lay groundwork that establishes a clinical trial infrastructure, adequately trained staff, and data tools/procedures preparatory to implementation of an interventional stroke burden reduction trial. In Phase 1/Aim 1, the investigators will conduct an epidemiological survey in 440 individuals to better understand stroke knowledge and attitudes. A sub-sample qualitative assessment will be conducted, using individual and group- format methodologies. In Phase 2/Aim 2, the study team will adapt a successful SMA initially developed for African-Americans. In Phase 3/Aim 3, the study team will select appropriate measures, train staff in measure implementation, and finalize the SMA for delivery using nurses and Peer Dyads (individuals who have had success in managing stroke risk factors). Finally, in a training/proof-of-concept exercise, the nurses and Peer Dyads will conduct the SMA with the 2 SMA targets (one group of up to 8 individuals at risk for stroke and one group of up to 8 individuals who have had stroke).