Outcomes of Traumatic Brain Injury

描述（由申请人提供）：本职业发展计划旨在使候选人，目前是社会医学和儿科助理教授，成为虐待儿童研究领域的独立临床医生和科学家。申请人与Desmond Runyan博士（儿童虐待研究的领导者）密切合作，作为她的主要赞助人，并已确定Stephen Hooper博士作为共同赞助人，因为他在神经发育评估方面的专业知识。该资助的培训部分包括与赞助方的监督工作，以及流行病学、儿童异常的生物学基础、用于儿科结果评估的测量工具的选择和理论背景的正式课程，以及负责任的研究行为。该应用程序还受益于cdc赞助的UNC伤害预防研究中心的合作，研究基础设施和补充资金，社会医学伦理导师，以及包括首席法医办公室和国家生命统计中心在内的全州公共卫生资源。研究部分是一项前瞻性的纵向研究，对全州范围内遭受任何类型的非穿透性创伤性脑损伤（TBI）的2岁以下儿童进行研究，这些儿童严重到足以在重症监护病房进行观察。它的独特之处在于，它将提供美国第一个基于人口的创伤性脑损伤（iTBI）数据。拟议的一系列研究建立在cdc赞助的一项研究（C. Runyan）中已经收集的数据基础上，与公共卫生数据的联系，以及该应用程序独有的数据，这些数据将在受伤后一到两年的随访中通过电话收集，并在儿童三岁生日后通过家访收集。研究1将确定非iTBI和iTBI的发病率和病死率，并比较两组之间的损伤模式和初始临床表现。研究2将利用对队列的随访电话来确定损伤后家庭的中间功能结局和非生物学数据。将探索非生物因素如何介导队列结果的模型。研究3将使用标准化的神经心理学测试，通过家访来确定创伤性脑损伤和非创伤性脑损伤儿童在发育认知和行为结果方面的差异。将收集有关儿童家庭的进一步资料，包括应付和家庭功能指数。假设是，创伤性脑损伤的儿童比非创伤性脑损伤的儿童表现更差，部分原因在于损伤类型，部分原因在于损伤后的家庭环境。将编制一个包含这三项研究的模型的初步数据。最后，研究4将描述iTBI儿童的初始和纵向社会和法律后果。除了出版物之外，这项指导研究的数据将用于制定额外的独立研究奖项。

DESCRIPTION (provided by applicant): This career development proposal is designed to prepare the candidate, currently an Assistant Professor of Social Medicine and Pediatrics, to be an independent clinician-scientist in the area of child abuse research. The applicant has worked closely with Dr. Desmond Runyan - a leader in child abuse research - as her primary sponsor, and has identified Dr. Stephen Hooper as a co-sponsor because of his expertise in neuro-developmental assessment. The training portion of this grant includes supervised work with both sponsors as well as formal courses in epidemiology, the biological basis of childhood exceptionalities, the selection and theoretical background of measurement tools used for pediatric outcome assessment, and responsible conduct of research. This application also benefits from the collaboration, research infrastructure, and supplemental funding of the CDC-sponsored UNC Injury Prevention Research Center, mentors in ethics within Social Medicine, and statewide public health resources including the Office of the Chief Medical Examiner and the State Center for Vital Statistics. The research component is a prospective, longitudinal study of a statewide population of children under age 2 years who have suffered any type of non-penetrating traumatic brain injury (TBI) that is serious enough to warrant observation in an intensive care unit. It is unique in that it will provide the first population based data of inflicted TBI (iTBI) in the United States. The series of proposed studies build on data already collected in a CDC-sponsored study (C. Runyan), linkages with public health data, and data unique to this application that will be gathered by telephone at one and two year follow-up from the injury, and by home visits after the child's third birthday. Study 1 will determine incidence and case fatality rates of non-iTBI and iTBI, as well as compare patterns of injury and initial clinical presentation between the two groups. Study 2 will utilize follow-up calls to the cohort to determine intermediate functional outcomes and non-biologic data about the post-injury family. A model of how non-biologic factors mediate cohort outcomes will be explored. Study 3 will utilize home visits to determine differences in developmental cognitive and behavioral outcomes between children with inflicted and non-inflicted TBI, using standardized neuropsychological tests. Further information will be collected on the child's family including indices of coping and family functioning. The hypothesis is that children with inflicted TBI will fare more poorly than children with non-inflicted TBI partially due to the injury type, and partially due to the post-injury family environment. Preliminary data on a model which encompasses these three studies will be developed. Finally, Study 4 will describe the initial and longitudinal social and legal ramifications for children with iTBI. In addition to publications, data from this mentored research will be used to develop additional, independent research awards.