Nurse Model in Black Families at Risk for Heart Disease

描述：(由申请人提供)家庭心脏研究将测试一种文化敏感的社区模式的短期影响，该模式由一名护士/健康教育团队(NORS团队)进行为期一年的风险因素护理，并在366名明显健康的30-59岁的非洲裔美国人兄弟姐妹中进行，这些兄弟姐妹明显健康，年龄在30-59岁之间，患有已知的过早冠心病(&lt；60岁)。一年的结果显示，与通常的护理相比，护理团队模式有显著的好处。我们不知道这些影响是否会持续下去。保持长期的危险因素控制对于降低有冠心病家族史的非裔美国人明显的冠心病高发至关重要。我们建议进行为期五年的跟踪调查，以确定NOS团队模式的长期影响。其目的是：(1)比较NOS团队干预和UC对低密度脂蛋白-胆固醇水平、收缩压和舒张压水平的五年影响，(2)确定(A)生物因素(肥胖和合并症)和(B)人口和心理社会因素(年龄、性别、教育程度、总体幸福感评分)对低密度脂蛋白-C水平和血压的独立贡献，以及(3)描述过早冠心病事件的发生率和隐匿性冠心病的进展。次要结果包括高密度脂蛋白胆固醇、甘油三酯、体重指数和戒烟率。五年后的饮食和体力活动分数将按组进行比较。我们假设，与UC相比，NORS团队将产生显著更好的长期低密度脂蛋白-C和血压水平。 我们建议采用MANCOVA分析方法进行群组随机试验、嵌套队列设计、单一基线、一年后测和五年随访评估。治疗组意外情况的影响将是最后一次随访时两种情况之间的差异，并根据基线风险因素水平的差异进行调整。家庭调整的生存分析将被用来检查临床和隐匿性冠心病随时间推移在高危非裔美国人兄弟姐妹中的模式。我们还使用标准的定性技术来更好地了解在五年内成功控制非裔美国人家庭风险因素的障碍和增强因素。这项研究提供了一个无与伦比的几乎第一次机会来描述非裔美国人的冠心病发病率，并确定在严重研究不足的高危人群中护士团队干预的影响。

DESCRIPTION: (provided by applicant) The family heart study will have tested the short-term impact of a culturally-sensitive community model of one-year of risk factor care by a nurse practitioner/health educator team (NURS TEAM) and usual primary provider care (UC) in 366 apparently healthy 30-59 year old African American siblings of index patients with known premature coronary disease (<60 years of age). One-year results show a significant benefit of the NURS TEAM model when compared with usual care. We do not know whether these effects will be sustained. Maintaining long-term risk factor control is of critical importance in reducing the notably high incidence of CHD in African Americans with a strong family history of CHD. We propose a five-year follow-up to determine the long-term impact of the NURS TEAM model. The aims are to: (1) compare the five year impact of the NURS TEAM intervention with UC, on levels of LDL-cholesterol, systolic blood pressure, and diastolic blood pressure, (2) determine the independent contribution of (a) biological factors (obesity and comorbidity) and (b) demographic and psychosocial factors (age, sex, education, general well-being scores) on levels of LDL-C and blood pressure, and (3) describe the incidence of premature CHD events and progression of occult CHD. Secondary outcomes include levels of HDL-C, triglycerides, body mass index, and smoking cessation rates. Diet and physical activity scores at five years will be compared by group. We hypothesize that the NURS TEAM will yield significantly better long-term levels of LDL-C and blood pressure compared with UC. We propose a MANCOVA analysis for a group-randomized trial, nested cohort design, with a single baseline, a one-year posttest and a five-year follow-up assessment. The effect of the treatment group contingency will be the difference between the two conditions at the last follow-up, with adjustment for differences in risk factor levels at baseline. Family-adjusted survival analyses will be used to examine the patterns of clinical and occult CHD over time in high-risk African American siblings. We also use standard qualitative techniques to gain a better understanding of barriers and enhancers to successful control of their risk factors over five years in African American families. The study provides an unparalleled virtually first opportunity to describe CHD incidence in African Americans and to determine the impact of NURS TEAM interventions in a seriously understudied high-risk population.