The latter half of this century has been characterized by an increasing prevalence of chronic disorders which contribute to premature mortality, impairment of function, and significant economic impact. Chronic disorders are defined as those which are permanent and require long periods of observation or care. Adjustment to the disorder or risk factors, prevention of complications, slowing of disease progression, and maintenance of function are the aims of most chronic disorder therapies. Management strategies must be directed toward improving or arresting clinical status as well as toward maintaining function and quality of life. Over the past five years the Center for Research in Chronic Disorders has provided infrastructure support for a center for excellent focusing upon the outcomes of chronic disorders, emphasizing quality of life, functional status, including cognitive function and, more recently, adherence to interventions for chronic disorders. This continuation application proposes to continue the emphasis these outcomes and expand the research base to include studies of the moderating effects of co-morbid conditions and sociodemographic characteristics on these outcomes. These outcomes can be examined both within and across disorders and populations, contributing to the enrichment of our knowledge related to the design of effective intervention strategies. In order to effectively promote and expand the research in this arena, we require the continuation of mechanisms to foster collaborative research, preliminary work which can lead to funded investigations, consultation and/or training and development in measurement and analysis strategies, support for data management and analysis, as well as resources for the development and dissemination of the science in this area. Consequently, building upon the experience of the Center, we are proposing: (1) an administrative core which will provide overall leadership, coordination, and oversight of the Center as well as support a pilot and feasibility program; (2) a statistics and data management core which will function as a data center, offering expert advice on methodology and analysis as well as direct support for forms development, data entry and management as well as statistical analysis; (3) a cognitive function core which will provide consultation, training and direct service on the selection, administration, as well as interpretation of neuropsychological assessments; and, (4) a research and development core which will offer activities to further develop investigators, promote scientific interaction among investigators, and support dissemination. The Center will be directed by Jacqueline Dunbar-Jacob, PhD, RN, FAAN.
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