Reducing stroke burden in Uganda

 描述(申请人提供)：中风是一种神经疾病，在许多低收入和中等收入国家中负担迅速增加。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症等危险因素的增加，非洲受到中风负担的打击尤其严重。尽管这些预测令人望而生畏，但中风往往是一种可以预防的大脑疾病。早期识别和处理危险因素可大大减轻中风负担。为响应PAR-14-331《全球大脑和神经系统疾病在生命周期中的作用》，拟议的项目将开发一种以人为中心的中风负担减轻方法，该方法将在乌干达实用有效，并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。这项拟议的研究包括来自乌干达坎帕拉的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成熟的记录，包括由NINDS资助的专注于神经疾病的医学教育伙伴计划(MEPI)。这个拟议的三期/三目标项目将；1.)对乌干达降低中风风险的障碍和促进者进行混合方法(定量、定性)评估；2)制定手册自我管理办法(SMA)，以降低具有多种风险因素的乌干达人的初级和继发性中风风险；3)为实施干预性卒中减负试验奠定基础，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。在阶段1/目标1中，调查人员将对440人进行流行病学调查，以更好地了解中风的知识和态度。将使用个人和小组形式的方法进行分样本定性评估。在阶段2/目标2中，研究小组将改编最初为非裔美国人开发的成功的SMA。在阶段3/目标3中，研究小组将选择适当的措施，培训实施措施的工作人员，并使用护士和同伴二人组(已成功管理中风风险因素的个人)敲定SMA以供交付。最后，在培训/概念验证练习中，护士和Peer Dyads将与2个SMA目标(一组最多8名中风风险患者和一组最多8名中风患者)一起进行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).