Mount Sinai Injury Control Research Center (MS-ICRC)

描述(由申请人提供)：西奈山伤害控制和研究中心(MS-ICRC)将在拟议的资助期内继续专注于改善创伤性脑损伤(TBI)后发生的第二和第三状态，以实现两个目标：(1)提高脑损伤后的生活质量和(2)延长40岁后受伤人员的寿命。 我们增加了一个额外的重点：减少高危青少年的暴力和犯罪行为。MS-ICRC的拟议研究计划包括：(1)调查行为干预对假释青少年(有脑外伤和无脑损伤)中暴力和累犯的影响。这项研究翻译了我们为成人脑外伤人群开发的干预措施，用于有暴力风险的青少年，它包括针对患有脑外伤的青少年罪犯的干预的第一项研究。(2)一项试验性前瞻性队列研究，对40岁以后遭受脑外伤的个体进行研究，以记录健康问题和其他可能导致脑外伤幸存者加速衰老和早熟死亡的因素。(3)对德克萨斯州少年司法系统开发的一个数据库进行分析，以探索脑外伤(和其他健康因素)与青少年犯罪之间的关系，特别是暴力犯罪。在这项政策研究之前，MS-ICRC广泛接触了德克萨斯州的青少年司法系统，导致他们决定对其人口进行脑损伤筛查(使用MS-ICRC的脑损伤筛查问卷[BISQ])。(4)在纽约市圣约翰大学建立所有大学运动员的纵向数据库，在大学入学时记录终身脑震荡史，然后前瞻性地记录大学期间在场上和场外持续的脑震荡。学生运动员将被跟踪以确定脑震荡的长期后果。该项目将完全自动化，以便在其他机构复制，以期建立全国大学运动脑震荡登记系统。(5)探索性项目计划，鼓励其他研究人员扩大他们的工作，以解决MS-ICRC的长期目标。总而言之，项目1和3对于制定全系统干预措施，以便尽早查明患有脑外伤的儿童并提供后续便利，即减少少年犯的暴力和犯罪行为的系统干预，或防止脑外伤儿童走上因犯罪行为受伤、无家可归和其他形式的社会失败而往往得不到治疗的长期挑战的学校干预措施，具有重大的政策意义。随着新的“产品”的开发和行动的新影响的出现，拟议的外联方案通过在我们当前活动(2007-2012年)的成果基础上再接再厉，并将拟议活动的结果编织到外联活动中，来实现MS-ICRC的目标。具体地说，已经制定、评估和手册了三项干预措施(适用于治疗脑外伤后抑郁的认知行为疗法，以及针对脑外伤后执行功能障碍的执行加和STEP治疗计划)。计划的外展将侧重于广泛传播和支持采用这些对脑损伤治疗武器库有价值的补充。目前的第二个重点是通过进一步验证BISQ及其对基于网络的管理的适应来筛查“隐藏的”TBI。未来五年的外联活动将强调更广泛地传播BISQ，以筛查更多的人口，目标是在学校和其他需要筛查的环境中改变政策，以确定与脑损伤相关的挑战，以便能够提供便利，防止与未识别的伤害相关的失败。另一个重点是与营销专家合作，更好地调整MS-ICRC的外联活动，以满足我们几个选民的需求。微软-红十字委员会对外宣传的一个新要素将是一个政策智库，以审查基于微软-红十字国际委员会研究和现有知识库的证据，然后详细说明实现政策变化的手段和战略；第一个领域将建立对“隐藏的”创伤性脑损伤的系统筛查。培训和教育方案将继续本着2007年建立的培训方案的精神，继续专注于向外地提供合格的专业伤害预防从业者和研究人员。正式培训将包括为期两年的博士后奖学金计划和为期一年的博士后外部奖学金。此外，我们将通过在专业会议和机构举行的网络研讨会和研讨会、研讨会和讲座来教育服务提供商；我们还为专业人员提供了大量可在我们的网站上免费下载的资源。还将制定将课程改革纳入医疗和其他专业培训计划的建议。

DESCRIPTION (provided by applicant): The Mount Sinai Injury Control and Research Center (MS-ICRC) will continue, in the proposed funding period, to focus on ameliorating the secondary and tertiary conditions that occur after traumatic brain injury (TBI), to address two goals: (1) improving quality of life after TBI and (2) extending the life span of people injured after age 40. We have added an additional emphasis: reducing violence and criminal behavior in youth who are at high risk. The proposed Research Program of the MS-ICRC includes: (1) An investigation of the impact of a behavioral intervention on violence and recidivism amongst youth (with TBI and without) who are on parole. This study "translates" an intervention we developed for an adult TBI population for use with adolescents at-risk for violence, and it comprises the first stud of an intervention for young offenders with TBI. (2) A pilot prospective cohort study of individual who sustained a TBI after age 40, to document health issues and other factors that may contribute to the accelerated aging and pre-mature death that has been documented in TBI survivors. (3) An analysis of a database developed by the Texas juvenile justice system to explore the relationship between TBI (and other health factors) and youth criminality, with a particular focus on violent offenses. This policy research follows extensive outreach by the MS-ICRC to the juvenile justice system in Texas that resulted in their decision to screen their population for TBI (using the MS-ICRC's Brain Injury Screening Questionnaire [BISQ]). (4) The establishment of a longitudinal database of all college athletes at St. John's University in New York City, to document at time of college admission lifetime history of concussion and to then prospectively document concussions sustained during college both on and off the field. Student-athletes will be followed to define the long-term consequences of concussions. This project will be fully manualized for replication in other institutions, to move toward the establishment of a national registry of college sports concussions. (5) A program of exploratory projects, to encourage other researchers to expand their work to address the MS- ICRC's long-term goals. Together, Projects 1 and 3 have strong policy implications for developing system-wide interventions to identify children with TBI at the earliest point possible and for providing subsequent accommodations, i.e., systemic interventions to reduce violence and criminality in young offenders, or school- based interventions to prevent children with TBI from taking the path that often leads from untreated long-term challenges consequent to injury to criminal behavior, homelessness and other forms of social failure. The proposed Outreach Program addresses MS-ICRC goals by building on the output of our current activities (2007-2012) and by weaving the results of proposed activities into outreach, as new "products" are developed and new implications for action emerge. Specifically, three interventions (cognitive behavioral therapy adapted to treat depression post TBI, and the Executive Plus and STEP treatment programs for post-TBI executive dysfunction) have been developed, evaluated and manualized. Planned outreach will focus on broad dissemination and support for adoption of these valuable additions to the TBI treatment arsenal. A second current focus is on screening for "hidden" TBI, through further validation of the BISQ and its adaptation for web-based administration. Outreach in the next five years will stress wider dissemination of the BISQ to screen additional populations, with the goal of effecting changes in policy in schools and in other settings where screening is needed to identify individuals with brain-injury related challenges, so that accommodations can be provided to prevent failure associated with unrecognized injury. Another emphasis is being placed on working with marketing experts to better tailor MS-ICRC outreach to meet the needs of our several constituencies. A new element of MS-ICRC outreach will be a Policy Think Tank, to review evidence based on MS-ICRC research and from the established knowledge base, and then to detail means and strategies to achieve policy change; the first area will be establishing systematic screening for "hidden" TBI. The Training and Education Program will continue to focus on supplying the field with qualified professional injury prevention practitioners and researchers, in the spirit of the training program established in 2007. Formal training will include a 2-year post-doctoral fellowship program and a 1-year pre-doctoral externship. In addition, we will educate service providers through webinars and workshops, symposia and lectures at professional conferences and institutions; we also provide numerous resources for professionals downloadable (gratis) on our website. Recommendations for curricula changes to be incorporated into programs for medical and other professional training will also be developed.