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中其负担迅速增加。由于人口快速增长、寿命延长、工业化模式、有害的西方饮食习惯以及高血压和肥胖等危险因素患病率的增加，非洲受到中风负担的影响尤为严重。 尽管预测令人畏惧，但中风通常是一种可以预防的脑部疾病。早期识别和管理危险因素可以大大减轻中风负担。该拟议项目是针对 PAR-14-331“整个生命周期的全球大脑和神经系统疾病”而编写的，将开发一种以人为本的减少中风负担的方法，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，并将为未来减少中风负担的努力发展研究能力。拟议的研究包括来自乌干达坎帕拉马凯雷雷大学和美国俄亥俄州凯斯西储大学的研究人员，他们在之前的合作中拥有成功且稳定的记录，其中包括由 NINDS 资助的专注于神经系统疾病的医学教育合作伙伴计划 (MEPI)。 这个拟议的三阶段/三个目标项目将： 1.) 对乌干达降低中风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)，以降低具有多种危险因素的乌干达人的原发性和继发性中风风险，以及 3.) 奠定基础，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，为实施介入性中风减负试验做好准备。在第一阶段/目标1中，研究人员将对440人进行流行病学调查，以更好地了解中风知识和态度。将使用个人和小组形式的方法进行子样本定性评估。在第二阶段/目标 2 中，研究团队将采用最初为非裔美国人开发的成功 SMA。在第 3 阶段/目标 3 中，研究团队将选择适当的措施，对工作人员实施措施进行培训，并最终确定 SMA 以供护士和同伴二人组（在管理中风风险因素方面取得成功的个人）实施。最后，在培训/概念验证练习中，护士和同伴二人组将根据 2 个 SMA 目标（一组最多 8 名有中风风险的人，一组最多 8 名患有中风的人）进行 SMA。

 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).