Community Health and Neuropathy: Nutritional and Environmental Links in Zambia (CHANNELZ)

社区健康和神经病：赞比亚的营养和环境联系 (CHANNELZ)

基本信息

批准号：
10360583
负责人：
Michelle Powell Kvalsund
金额：
$ 16.76万
依托单位：
UNIVERSITY OF ROCHESTER
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-08-05 至 2025-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10360583
关键词：
Adult Africa South of the Sahara Age Area Clinic Clinical Clinical Trials Communicable Diseases Communities Community Health Complex Data Development Diabetes Mellitus Diagnostic Dietary Factors Dietary Intervention Dietary intake Distal Environment Epidemiologic Methods Etiology Factor Analysis Folic Acid Folic Acid Deficiency Food Foot Ulcer Foundations Functional disorder Future Gender Goals HIV HIV Seronegativity Health Policy Health care facility Healthcare Homocysteine Household Individual Intervention Intervention Studies Knowledge Lead Link Maize Malnutrition Manihot Manuscripts Mentorship Metabolic Methodology Micronutrients Modeling Morbidity - disease rate Nature Neurologic Neurologist Neuropathy Nutritional Observational Study Outcome Assessment Pathogenicity Patient Care Pattern Peer Review Persons Phenotype Plasma Polyneuropathy Population Population Analysis Pragmatic clinical trial Predisposition Prevalence Province Quality of life Recurrence Research Research Training Risk Risk Factors Rural Sampling Scientific Advances and Accomplishments Structure Surveys Thiamine Thiamine Deficiency Time Validation Vitamin B 12 Vitamin B 12 Deficiency Zambia axonopathy base case control chronic pain comorbidity comparative design dietary experience falls food insecurity global health health care settings improved limb amputation member micronutrient deficiency neurotoxic nutrient deprivation nutrition population based public health intervention regional difference rural residence screening sex skills

项目摘要

Project Summary/Abstract The overarching goals of this project are to advance knowledge of the complex pathophysiology of distal symmetric polyneuropathies (DSP) and frame future interventions for nutritional neuropathies in Zambia through: 1) assessment of population-based estimates and risk factors for DSP in Zambia’s maize and cassava staple food zones; 2) comparison of population-based estimates and risk factors to previous clinic- based data from the same maize-staple districts; 3) and assessing the odds of specific micronutrient deficiencies among DSP cases and age, gender, and HIV-matched controls from the same districts. To accomplish these goals, Dr. Kvalsund will focus on acquisition of additional expertise and experience in the following key areas: 1) advanced epidemiological methods and analysis; 2) clinical trials methodologies, 3) global health policy; 4) neuropathy outcome assessments; and 5) HIV and nutrition. The needed skills will be achieved through structured mentorship, coursework, and pragmatic clinical trials and health policy experiences. The research-training plan will provide Dr. Kvalsund with the additional proficiency necessary to undertake future intervention research aimed at reducing nutrition-associated neurologic morbidity in Zambia and advancing scientific knowledge of the pathophysiologic mechanisms that generate DSP as a common phenotype. The central hypothesis is that the high rate of DSP previously observed in clinic populations in Zambia is equally prevalent outside healthcare settings owing to common endemic infectious diseases and their neurotoxic treatments, food insecurity and low dietary diversity, recurrent nutritional challenges, specific micronutrient deficiencies and their interactions, and possibly other unidentified latent factors. We hypothesize that folate-deficiency will be highly associated with DSP in Zambian communities, as has been documented in clinic populations, and may warrant a targeted public health intervention given the preventable nature and range of other neurologic morbidities also associated with folate deficiencies. The specific aims are to: 1) Determine population-based DSP estimates in Zambia; 2) Compare and contrast DSP estimates and risk factors with those from clinical settings in Zambia; 3) to consider the relative contributions of urbanicity, agroecological/staple food zone, and specific micronutrient deficiencies on DSP prevalence; and 4) Evaluate for latent environmental or toxico-dietary factors as contributors to DSP in this environment. The research is expected to provide the foundation for future R-01 intervention and observational research and to improve scientific understanding of how diverse etiologies, multiple exposures and interactions lead to a common clinicopathologic DSP phenotype, which remains poorly understood to date.

项目摘要/摘要该项目的总体目标是促进对不同不同病理生理学的了解赞比亚营养神经病的对称多神经病（DSP）和未来的干预措施通过：1）赞比亚玉米中DSP的基于人群的估计和风险因素的评估木薯主食; 2）比较以前的诊所的基于人群的估计和危险因素来自同一玉米堆区的基于数据； 3）并评估特定微量营养素的几率 DSP案件和年龄，性别和艾滋病毒匹配的控制的缺陷。到实现这些目标，Kvalsund博士将专注于获得其他专业知识和经验以下关键领域：1）高级流行病学方法和分析； 2）临床试验方法，3）全球卫生政策； 4）神经病结果评估； 5）艾滋病毒和营养。所需的技能将是通过结构化的心态，课程和务实的临床试验和健康政策实现经验。研究培训计划将为Kvalsund博士提供所需的额外熟练程度进行未来的干预研究，旨在减少赞比亚营养相关的神经系统发病并促进对生成DSP的病理生理机制的科学知识表型。中心假设是先前在临床人群中观察到的高率由于常见的内在传染病和他们的神经毒性治疗，粮食不安全和低饮食多样性，经常出现的营养挑战，具体微量营养素缺陷及其相互作用，以及可能其他未知的潜在因素。我们假设叶酸缺乏将与赞比亚社区的DSP高度相关，如诊所人口，并可能保证有针对性的公共卫生干预措施，并且鉴于可预防的性质其他神经病病毒的范围也与叶酸缺陷有关。具体目的是：1）确定赞比亚的基于人群的DSP估计； 2）比较和对比DSP估计和风险赞比亚临床环境的因素； 3）考虑城市的相对贡献， DSP患病率的农业生态/主食食品区和特定的微量营养素缺陷； 4）评估对于潜在的环境或毒性因素，作为在这种环境下的DSP的贡献者。研究是预计将为未来的R-01干预和观察研究提供基础，并改善科学理解对多样化，多种暴露和相互作用如何导致共同迄今为止，临床病理DSP表型尚未理解。