Aims Dyslipidemia is a major modifiable risk factor for stroke; however, it is poorly understood among patients at risk of stroke in Uganda. This study is aimed at determining the prevalence of dyslipidemia and identifying associated factors among a Ugandan sample at risk for stroke. Methods This was a hospital based cross-sectional study conducted across three Ugandan sites. The serum lipid levels were determined following the National Cholesterol Education Program guidelines. Data were analyzed with STATA employing univariable and multivariable logistic regression. Statistical significance was set at p < 0.05. Results We enrolled 247 study participants with a mean age (SD) of 55.4 (12.0) years. Majority of the participants were female, n = 168 (68%). About 81% (N = 199) had elevated serum lipid levels. Sixty-one (24.7%) had elevated levels of total serum cholesterol, whereas half of female participants had abnormally low levels of HDL cholesterol. About a third (N = 82 and 84, respectively) had elevated serum LDL and triglycerides. Nearly 40% (N = 98) were obese and 23.5% had a sedentary lifestyle (N = = 58). Only 20.2% (N = 50) were receiving lipid lowering drugs. Prior family stroke history and personal history of stroke had lower odds of 58% (AOR = 0.42, 95% CI: 0.20-0.88, p = 0.022); and 64% (AOR = 0.36, 95% CI: 0.17-0.76, p = 0.008), respectively, of having dyslipidemia. Conclusions Approximately four in five Ugandans at risk of stroke have dyslipidemia. The majority also have low HDL-c levels. Implementation of systematic screening and provision of statin therapy among those at high risk for stroke is urgently needed to reduce stroke burden in Uganda. Trial Registration ClinicalTrials.gov identifier: NCT04685408

This 6-month randomized controlled trial compared TEAM, a group intervention to reduce stroke risk versus a 6-month wait-list control in Black men with stroke or transient ischemic attack. The primary outcome was the change from baseline to 6 months in systolic blood pressure (SBP). There were 160 randomized, N = 78 to TEAM, N = 82 to Waitlist, mean age 61.2 ( SD 9.5). Attrition was 53.1% and similar across arms. Biomarker values were extracted from health records for individuals with missed visits. Baseline SBP was 135.3 ( SD 17.9). Among the entire sample, SBP was numerically but not statistically significantly reduced with no significant difference between TEAM versus Waitlist. Post-hoc analyses suggested those with elevated baseline blood pressure (BP) had significant BP reduction in the group as a whole and in TEAM. Future research might target Black men with poorly controlled BP and address barriers to engaging in risk reduction programs.

PurposeThis study examined the use of personal and social resourcefulness when experiencing anger, anxiety, sadness, decision-making, and financial distress among adult-child and spousal caregivers of persons with dementia.MethodsBaseline data on 10 Resourcefulness Scale© items measuring personal and social resourcefulness in response to anger, anxiety, sadness, decision-making, and financial distress were obtained from 127 adult-child and 112 spousal caregivers of persons with dementia.ResultsAdult-child and spousal caregivers similarly used personal resourcefulness for financial distress (62%-68%) and both personal and social resourcefulness when angry (67%), sad (87%-92%), and making decisions (77%-98%). Spousal caregivers used both personal and social resourcefulness when anxious (37%), while adult-child caregivers used only personal resourcefulness (46%). The findings were similar across age, race, and gender subgroups.ConclusionsFuture research should explore the effects of other situational factors (e.g., caregiving burden) on resourcefulness. Gerontological healthcare professionals should assess the caregiver-care recipient relationship when determining and tailoring interventions.

Background and Purpose: The aim of the study was to examine the psychometric properties of the Sickle Cell Self-Efficacy Scale (SCSES) in an anonymous, online cohort of adults with sickle cell disease (SCD). Methods: The SCSES was completed by 60 adults with SCD. An exploratory factor analysis was conducted. Convergent validity and discriminant validity were assessed using bivariate correlations between the SCSES and other study variables, and internal consistency reliability was evaluated through examining an alpha coefficient. Results: A unidimensional factor structure explained 49.6% of the variance in self-efficacy. The SCSES demonstrated convergent validity and discriminant validity with the select battery of measured concepts and sufficient internal consistency reliability (coefficient alpha = .87). Conclusions: The SCSES remains a valid and reliable measure of SCD self-efficacy among adults when used in anonymous, online research.

This analysis of baseline data from a clinical trial evaluated factors associated with blood pressure (BP) control among 160 Black men with stroke or transient ischemic attack (TIA). Aggregate analysis evaluated demographic (age, health insurance status, living-alone status), clinical (time since stroke/TIA, somatic comorbidities), and social variables (health literacy, stress and discrimination) in relation to BP. Baseline BP readings were available for 146 (91.3

Every minute, a family member begins their "caregiving career" with the primary responsibility of caring for someone with dementia. Their career may progress through in-home caregiving (i.e. caregivers), to partnering with a facility (i.e. care partners), to caretaking after bereavement (i.e. caretakers). Although each phase presents challenges that adversely affect one's health, responses to such challenges (i.e. stress, cognitions, and emotions) and strategies to manage them (i.e. resourcefulness) may vary across the career trajectory. Resourcefulness Theory© informed this preliminary analysis of baseline data from a randomized trial with 145 caregivers, 111 care partners, and 62 caretakers of persons with dementia recruited from the community and online. The three groups were compared on measures of stress, depressive cognitions, negative emotions, and resourcefulness (personal, social, and spiritual) using one-way analysis of variance. The three groups reported similar stress (F = 0.986; p = 0.374), depressive cognitions (F = 0.184; p = 0.832), and negative emotions (F = 0.123; p = 0.884). Mean scores indicated moderate stress (M = 20.08; SD = 7.21), moderate risk for depression (M = 9.23; SD = 6.83), and substantial negative emotions (M = 6.80; SD = 2.81). Resourcefulness scores for all three groups indicated a moderate need for resourcefulness training, however, they differed (personal: F = 2.94; p = 0.027; social: F = 2.44; p = 0.045; spiritual: F = 4.00; p = 0.010) with caretakers scoring lowest. The findings indicated that across the "caregiving career," there were similar responses to caregiving challenges regardless of caregiving phase. Future research should identify contextual factors associated with those responses. Although resourcefulness scores indicated all three groups would benefit from resourcefulness training, bereaved caretakers showed the greatest need, suggesting the importance of teaching them resourcefulness skills.

Background: Neurological disorders remain a challenge in sub-Saharan Africa, with limited expertise and credible research data to guide interventions and disease prevention. Training the next generation of clinical researchers requires a focused and concerted effort to stem the growing neurological disease burden. The US National Institute of Health (NIH) research training funded through the Fogarty International Center (FIC) Global Brain Disorders Research program gave trainees an opportunity to participate in mentored neurology research and training for 1-2.5 years. We conducted a descriptive cross-sectional study among mentees of 2 FIC research programs to assess the training experience and inform program refinement. Methods: The data were collected via an online questionnaire created using Google Forms. All participants who had participated in the prior brain health research training programs received an online survey form. The form included a brief instruction with review guidance on the methodology to be used in training, and its objectives were provided. We used a descriptive analytical approach where we assessed the perceived interest in medical research, barriers to mentorship, satisfaction with the current mentorship and barriers to the current training program. Results: About half of the trainees are male, and the majority, 62/72, reported that they had participated in research studies before enrolling for their training and few (11.1%) had a research experience of more than 3 years. Overall, 97.2% (70/72) reported that they were interested in conducting medical/neurology research as part of their career as a clinician, with 80.5% indicating that they were very interested. There were no significant differences across the several areas of interest regarding the level of satisfaction based on age groups and gender. Conclusion: Barriers still exist for brain health research training in sub-Saharan Africa (SSA) and efforts to improve more protected time for research, mentorship growth and tailored research training courses are still needed to increase support for young research scientists in SSA.

OBJECTIVE:Even with recruitment efforts for racial and ethnic minorities in dementia research, there is still underrepresentation in these communities. Targeting barriers and facilitators to research participation, we developed and tested a culturally tailored communication approach tailored for Hispanics. METHODS:An iterative process informed by input from the minority advisory board of an Alzheimer's Disease Research Center, developed 2 brief health communication videos, featuring Hispanic actors/Spanish language sub-titles. The experimental video (POWER) focused on barriers, facilitators, and readiness to participate in dementia research. The control video focused on education only. A randomized prospective survey compared POWER vs. control. While race or ethnicity were not inclusion criteria for enrollment, we oversampled Hispanic and non-white communities. We examined change pre- vs. post-video on dementia knowledge, cumulative barriers, and facilitators to research participation, as well as change in research readiness measured by the Transtheoretical behavior change model. RESULTS:The analyzable sample (N = 184) had a mean age of 40.0 (SD = 13.2) years, 57.4% (n = 105) female, 47.2% (n = 85) non-white, 21.2% (n = 39) Hispanic, with 88 individuals randomized to POWER and 96 to control. Unadjusted evaluation of change from pre- vs. post-video showed significant improvements in dementia knowledge, research facilitators and research barriers (all ps < .001) but no significant difference between POWER vs. controls. Adjusted for age, gender, race, ethnicity and education, only change in dementia knowledge remained significantly improved for the group as a whole, with no significant difference between POWER vs. controls. In the entire sample, Hispanics had significantly more improvement in research readiness (r = .217, p = .003). Exploratory analysis of positive change predictors in those randomized to POWER and to control suggests Hispanics in POWER may be at a disadvantage with respect to dementia knowledge (r = -.248, p = .02) and research facilitators (r = -.342, p = .001). CONCLUSIONS:Health communications can improve dementia knowledge across diverse communities.

Background: Magnesium sulphate (MgSO4) is a drug used to prevent and treat preeclampsia with severe features (PEC) and eclampsia in pregnant women. MgSO4 is also known to readily cross the placenta, fetal membranes and into the fetus and amniotic fluid and may produce hypotonia and hypotension. We set out to assess immediate newborn outcomes of early neonates born to mothers with preeclampsia receiving MgSO4 during intrapartum period. Methods: This was an analytical observational cohort study at Kawempe National Referral Hospital in Uganda. Two hundred ten pregnant mothers with PEC or eclampsia were recruited in the study after receiving the loading dose of MgSO4 and then followed through labour and delivery to observe immediate newborn outcomes using Apgar score and the hospitalized newborns were followed through their first seven days of life and scored using Thompson scores. SPSS version 23 was used to analyse data to report frequencies, means and relationships between variables through chi square and analysis of variance (ANOVA) tests. P values <0.05 were considered statistically significant. Results: The majority, 178/210 (84.8%), of the mothers delivered live babies, while 32/210 (15.2%) delivered stillbirths (13/32; 40.6% FSBs and 19/32; 59.4% MSBs). The mean (SD) Apgar score was 9.02 (1.45) with the majority 166/210 (93.3%) of the newborns having seven or higher. Factors significantly associated with the Apgar scores were maternal diagnosis (p<0.001) and NICU admissions (p<0.001). Apgar scores significantly differed by the gestational age (p<0.001), liquor state (p<0.001), labor induction (p<0.001) and birth weight (p<0.001). The mean (SD) Thompson score was 3.31 (±4.63) units. The majority 37/55 (67.3%) of the children had mild Hypoxic-Ischemic Encephalopathy (HIE) whereas 17/55 (30.9) were normal without HIE. Only one child had severe HIE. Thompson scores significantly differed by the mode of delivery (p<0.033). Conclusions: The majority of NICU admissions were caused by respiratory issues and preterm deliveries. The significant number of newborns experiencing mild HIE puts these infants at risk for both immediate and long-term complications. Therefore, extreme care must be exercised when giving MgSO4 to mothers, as improper administration of the drug could further endanger the health and well-being of the newborns.

Background Older adult mistreatment occurs in many as one-half of dementia care partners. Psychological mistreatment is the most common form of older adult mistreatment by family caregivers and is known to create mental health morbidities among care recipients. The Knowledge and Interpersonal Skills to Develop Enhanced Relationships (KINDER) intervention is among the first older adult mistreatment prevention interventions focused on family caregivers. KINDER was designed to prevent psychological mistreatment of older adults. Caregivers found the initial asynchronous web-based version (KINDER 1.0) to be acceptable but expressed a desire to engage with other family caregivers. KINDER was revised to integrate 3 facilitated small group discussion sessions conducted by videoconference. This study examines the acceptability of a revised KINDER intervention. This research addresses the extent to which caregivers find a novel approach to older adult mistreatment prevention to be acceptable. Objective This study aims to evaluate the acceptability of the revised KINDER intervention. Methods The investigators conducted semistructured qualitative interviews with a purposive sample of family caregivers following participation in KINDER (N=11) and collected postintervention survey data (N=71). The qualitative interview codebook and survey questions were informed by the Theoretical Framework of Acceptability by Sekhon et al. Components of acceptability in this framework include affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, and self-efficacy at completing activities. Qualitative interviews were coded by 2 independent coders using a thematic analytic approach. Survey data were analyzed using frequencies and percentages. Results Of the 98 caregivers who attended KINDER, 71 (72%) completed satisfaction surveys. Caregivers reported high levels of overall satisfaction with KINDER; 80% (53/66) of participants reported they were “Very Satisfied” with the intervention, and 20% (13/66) indicated they were “Satisfied.” More than 80% of caregivers (56/69, 81%) rated the newly added group discussions as being “Very valuable.” Qualitative findings supported positive attitudes revealed in survey responses. Themes addressed (1) the interventions’ alignment with caregiver values (affective attitude, intervention coherence, ethicality), (2) beliefs about the effectiveness of the program (perceived effectiveness), (3) difficulty participating in the program relative to its perceived overall value (burden, opportunity cost, self-efficacy), and (4) recommendations to further improve the intervention. Conclusions These findings indicate that KINDER was well received among family caregivers, who reported high levels of satisfaction and positive feedback on its components. The addition of virtual group discussion sessions was particularly valued. The use of multiple data collection methods in this research provided a comprehensive understanding of caregiver experiences. This study contributes to current knowledge by demonstrating the acceptability of a novel intervention to prevent older adult mistreatment by family caregivers to persons with dementia. Future research should focus on testing the efficacy of KINDER and exploring its implementation in health and social service settings. Trial Registration ClinicalTrials.gov NCT05783102; https://clinicaltrials.gov/study/NCT05783102

Objective: Even with recruitment efforts for racial and ethnic minorities in dementia research, there is still underrepresentation in these communities. Targeting barriers and facilitators to research participation, we developed and tested a culturally tailored communication approach tailored for Hispanics. Methods: An iterative process informed by input from the minority advisory board of an Alzheimer's Disease Research Center, developed 2 brief health communication videos, featuring Hispanic actors/Spanish language sub-titles. The experimental video (POWER) focused on barriers, facilitators, and readiness to participate in dementia research. The control video focused on education only. A randomized prospective survey compared POWER vs. control. While race or ethnicity were not inclusion criteria for enrollment, we oversampled Hispanic and non-white communities. We examined change pre- vs. post-video on dementia knowledge, cumulative barriers, and facilitators to research participation, as well as change in research readiness measured by the Transtheoretical behavior change model. Results: The analyzable sample (N = 184) had a mean age of 40.0 (SD = 13.2) years, 57.4% (n = 105) female, 47.2% (n = 85) non-white, 21.2% (n = 39) Hispanic, with 88 individuals randomized to POWER and 96 to control. Unadjusted evaluation of change from pre- vs. post-video showed significant improvements in dementia knowledge, research facilitators and research barriers (all ps < .001) but no significant difference between POWER vs. controls. Adjusted for age, gender, race, ethnicity and education, only change in dementia knowledge remained significantly improved for the group as a whole, with no significant difference between POWER vs. controls. In the entire sample, Hispanics had significantly more improvement in research readiness (r = .217, p = .003). Exploratory analysis of positive change predictors in those randomized to POWER and to control suggests Hispanics in POWER may be at a disadvantage with respect to dementia knowledge (r = -.248, p = .02) and research facilitators (r = -.342, p = .001). Conclusions: Health communications can improve dementia knowledge across diverse communities.

Elder mistreatment occurs in as many as one-half of the 11 million family care partnerships with persons living with Alzheimer's disease or related dementias (AD/ADRD) in the United States. Knowledge and Interpersonal Skills to Develop Enhanced Relationships is an 8-week psychoeducational intervention to prevent psychological mistreatment among family caregivers to persons living with dementia by building healthy caregiving relationships. The investigators conducted a single-arm pre- and posttest study to assess KINDER's feasibility. A total of 45 caregivers enrolled, among whom 37 completed the follow-up survey (82.2% retention). Caregivers attended an average of 2.1 of 3 discussion sessions (SD = 0.76). Paired t-test analyses comparing outcomes at baseline and post-intervention demonstrated a statistically significant decrease in psychological mistreatment and relationship strain, and an increase in resourcefulness skills. These findings suggest KINDER is a feasible low- to moderate-intensity intervention to prevent psychological mistreatment with AD/ADRD caregiving. Future research will test KINDER's efficacy.

BACKGROUND:Among low and middle-income countries, especially in Sub-Saharan Africa, the stroke burden is severe, with increasing trends in stroke incidence, prevalence, and mortality. AIMS:This 6-month, prospective randomized controlled trial (RCT) compared a novel stroke risk reduction approach (TargetEd manAgeMent Intervention (TEAM)) vs. Enhanced Treatment as Usual (ETAU) in 247 Ugandans at risk for stroke. METHODS:Participants, enrolled across 3 Ugandan sites, were adults with high stroke risk. The primary outcome was a change in systolic blood pressure (SBP) from baseline to 6-month follow-up. Secondary outcomes included changes from baseline to 6 months on diastolic BP (DBP), serum lipids, glycosylated hemoglobin (HbA1c), self-efficacy and stress. RESULTS:The mean sample age was 55.4 (±SD = 12.0) with majority being women (n = 168, 68%). In addition to hypertension, the most common risk factors were hyperlipidemia (n = 199, 80.6%) and obesity (n = 98, 39.7%). Overall mean SBP and DBP at baseline were 143.0 (SD = 19.8, range 94.5-206) and 89.3 (SD = 14.0, range 61-136) respectively. In TEAM, SBP significantly improved from 145.7 (±21.5) at baseline to137.4 (±18.1) at 6-months vs. change from 141.9 (±18.4) to 141.1 (±21.9) for ETAU (p = 0.031). There were similar reductions in DBP favoring TEAM (p = .012). Compared to ETAU, TEAM showed improved physical activity (p = .017), self-efficacy (p < .001) and stress (p = .014). CONCLUSIONS:There is a need for effective and practical approaches to reduce stroke burden in Sub-Saharan Africa. Inclusion of the TEAM approach in primary care seems to be a pragmatic and effective way to potentially reduce stroke burden in Uganda. TRIAL REGISTRATION:ClinicalTrials.gov identifier: NCT04685408, registered on 28 December 2020.

Introduction Even with recruitment efforts for racial and ethnic minorities in dementia research, there is still underrepresentation in these communities. Targeting barriers and facilitators to research participation, we developed and tested a culturally tailored communication approach tailored for Hispanics. Methods An iterative process informed by input from the minority advisory board of an Alzheimer’s Disease Research Center, developed 2 brief health communication videos, featuring Hispanic actors/Spanish language sub-titles. The experimental video (POWER) focused on barriers, facilitators, and readiness to participate in dementia research. The control video focused on education only. A randomized prospective survey compared POWER vs. control. While race or ethnicity were not inclusion criteria for enrollment, we oversampled Hispanic and non-white communities. We examined change pre vs. post-video on dementia knowledge, cumulative barriers, and facilitators to research participation, as well as change in research readiness measured by Transtheoretical behavior change model. Results The analyzable sample (N= 184) had a mean age of 40.0 (Standard deviation/SD 13.2) years, 57.4% (n=105) female, 47.2% (n=85) non-white, 21.2% (n=39) Hispanic, with 88 individuals randomized to POWER and 96 to control. Unadjusted evaluation of change from pre vs. post-video showed significant improvements in dementia knowledge, research facilitators and research barriers (p LESS THAN .001 all) but no significant difference between POWER vs. controls. Adjusted for age, gender, race, ethnicity and education, only change in dementia knowledge remained significantly improved for the group as a whole, with no significant difference between POWER vs. controls. In the entire sample, Hispanics exposed to any communication had significantly less improvement in research readiness (r= -.217, p=.003). Exploratory analysis of positive change predictors in those randomized to POWER and to control suggests Hispanics in POWER may have an advantage with respect to dementia knowledge (r=.248, p=.02) and research facilitators (r=.342, p=.001). Conclusions Health communications can improve dementia knowledge across diverse communities.

Background:The COVID-19 pandemic, combined with the shortage of nursing staff, contributed to higher levels of stress. Sustained stress has been associated with burnout. However, nurses have traditionally demonstrated resourcefulness skills that resulted in building resilience. Observations:This pilot project recruited US Department of Veterans (VA) registered and advanced practice nurses to participate in a resourcefulness skills training initiative. VA nurses were found to have a moderate level of burnout at baseline. Nurses participated in Resourcefulness Training to handle stress and possible burnout. Resourcefulness Training themes included accessing family and peer support, developing organizational and problem-solving skills, and using distraction. Conclusions:Nurses must be vigilant in appraising and managing their ability to cope and adapt to individual stress, while also being aware of their colleagues' stress levels. Educational institutions, professional organizations, and health care facilities must strive to educate and support nurses in identifying stress and healthy coping mechanisms. In this project, relying on family and peers emerged as an important resourcefulness skill.

BACKGROUND:Although resourcefulness has been successfully taught during formal training programs, it can also be acquired informally through life experiences. Family caregivers have many opportunities for learning to be resourceful on their own and those who participate in research may acquire knowledge or skills that increase their resourcefulness. The effects of such differential experiences on the resourcefulness of family caregivers have not been examined over time. OBJECTIVE:This study compared changes in resourcefulness over time in caregivers who received no intervention, an educational program, biofeedback, or Resourcefulness Training©. METHODS:This longitudinal analysis of data from a randomized controlled trial involved 219 caregivers of persons with bipolar disorder who completed the Resourcefulness Scale© before no intervention, an educational program, biofeedback, or Resourcefulness Training, and at 6 and 12 months afterward. Differences across the groups were examined using RMANOVA. Patterns of mean scores including differences and linear trends in resourcefulness for the four groups were examined. RESULTS:Overall, caregivers increased linearly in resourcefulness over time [F(1,215) = 4.836, P = .015]. Although each group showed improvement in resourcefulness, caregivers who received Resourcefulness Training showed the greatest improvement from baseline (estimated mean = 88.244, SE = 2.734) at both 6 months (estimated mean = 92.610, SE = 2.813, P = .026) and 12 months post-intervention (estimated mean = 95.049, SE = 2.752, P = .003). CONCLUSIONS:Consistent with resourcefulness theory, the findings showed caregivers of persons with bipolar disorder became more resourceful over time with or without formal training. However, those who received Resourcefulness Training demonstrated resourcefulness skills sooner and to a greater extent, thereby providing the rationale for formal Resourcefulness Training programs.

Background:Epilepsy is a common chronic brain disorder globally affecting people of all ages, with the majority living in developing countries. The introduction of epilepsy self-management approaches to help people with epilepsy is urgently needed to influence epilepsy-related outcomes. This 2-site randomised controlled trial building on promising preliminary data is intended to explore this further. Methods:A total of 188 adult people with epilepsy (PWE) attending the neurology clinics at Mulago and Mbarara hospitals and consent to participate in the study. They will be randomised into intervention versus enhanced treatment control (eTAU) study groups. The intervention group will receive 12-week "intensive" educational sessions and a 12-week remotely accessed telephone follow-up stage. The controls will continue in their usual care supplemented by written materials on epilepsy in their preferred language and tailored to the reading level of most patients at the clinic. SMART-U consists of 2 main components: a 12-week "intensive" group format stage and a 12-week remotely accessed telephone follow-up stage. SMART-U will be assessed for acceptability, fidelity, and efficacy compared to eTAU. The primary study outcome is the mean change in cumulative past 24-week seizure frequency (24 weeks prior to the study baseline compared to the 24-week follow-up). Seizure frequency will be via self-report with corroboration by family/support system informants whenever possible. Participants will self-report their seizure frequency (numeric count) that they experienced between baseline and 13 weeks and again between 13 and 24 weeks and the mean change from baseline to 24 weeks in QOL. Discussion:The curriculum-guided Self-Management intervention for Reducing The epilepsy burden among Ugandans (SMART-U) program is anticipated to reduce the epilepsy burden seizure frequency and improve other health outcomes, including depression, functional status and health resource use. Trial Registration Number TRN:NCT06139198. Date of registration:14th November 2023.

Background:Stroke risk factors are an emerging public health problem in Sub-Saharan Africa. This analysis examined demographic and clinical correlates of blood pressure (BP) in a Ugandan sample at risk for stroke. Methods:This cross-sectional analysis of demographics (age, gender, marital status, education level, rural/suburban/urban status, employment status), stroke risk factors (diabetes, hyperlipidemia, obesity, smoking status, sedentary life-style, problem alcohol use), and clinical variables associated with systolic BP (SBP) and diastolic BP (DBP) were derived from the screening and baseline sample of a prospective, randomized effectiveness-implementation trial. ClinicalTrials.gov identifier: NCT04685408, registered on 28 December 2020, testing a novel stroke risk reduction approach (TargetEd manAgeMent Intervention (TEAM) conducted across 3 Ugandan sites. We examined variables with respect to an established set of guidelines for hypertension (HTN) severity, the European Society of Cardiology (ESC) and European Society of Hypertension (ESH) Guideline (ESC-ESH). Results:Of this total sample of 247, the mean sample age was 55.4 years (Standard deviation/SD =12.0), and largely female, n=168 (68%). In addition to HTN, the most common sample stroke risk factors were hyperlipidemia (n=199, 80.6%) and obesity (n= 98, 39.7%). The majority (n= 238. 96.4%) were prescribed at least one medication to treat HTN. Mean SBP and DBP at baseline were 143.0 (SD=19.8, range 94.5-206) and 89.3 (SD =14.0, range 61-136) respectively. ESC-ECH classifications were grouped into grades of increasing severity from mildest (Grade 1) to the most severe (Grade 3). An additional < Grade 1 was created to reflect individuals whose ESC-ECH scores dropped below Grade 1 post-screening. There were few significant differences across ESC-ECH groups, except that having diabetes, being sedentary and being a smoker were associated with higher ESC-ECH grades. Conclusions:To help reduce stroke burden in Uganda, our findings support the importance of raising awareness of HTN and the helping individuals to manage their HTN with both medications and life-style approaches.

Abstract To address the well-documented stress and health challenges faced by grandmothers raising grandchildren, a sample of 342 grandmothers living with grandchildren participated in a national online, NIH funded randomized clinical trial testing two methods to reduce stress. We evaluated whether the 4-week Grandmother Initiatives in Family Transformation (GIFT) intervention (Resourcefulness Training © via video plus structured journaling) compared to a 4-week unstructured journal-only condition (with video instruction) improved grandmothers’ individual and family well-being: a) mental health (general mental health and depressive symptoms), b) physical health (self-rated and general health), c) family well-being (family functioning) and d) resources (resourcefulness, support, and reward) at 2, 12, and 24 weeks post-intervention. We ran RM-ANOVA for each outcome, looking at changes over time, time by arm, time by days journaling, and time by number of video views for their arm. Grandmothers in both arms showed significant improvements on general mental health and family functioning and reduced depressive symptoms and stress across time, establishing that both arms received helpful interventions; there were no changes in physical health indicators. Participants in both arms reported improved resourcefulness, support, and caregiving reward. Significant improvements over time in mental health and support were reported by participants journaling more frequently. The number of video views was significant over time only for resourcefulness, although there were between-subjects effects for video views for general mental health and depressive symptoms. Implications for online interventions to reduce stress, and the impact of active participation (journaling, practice and video support) are discussed.