Outcomes of Traumatic Brain Injury

描述(由申请人提供)：这份职业发展建议书旨在帮助目前担任社会医学和儿科学助理教授的候选人成为虐待儿童研究领域的独立临床医生兼科学家。申请者与虐待儿童研究领域的领军人物德斯蒙德·鲁尼安博士密切合作，作为她的主要赞助人，并因斯蒂芬·胡珀博士在神经发育评估方面的专业知识而将其列为共同赞助人。这笔赠款的培训部分包括与赞助商的监督工作以及流行病学的正式课程、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，以及负责任的研究行为。这项申请还受益于CDC赞助的北卡罗来纳州伤害预防研究中心、社会医学中的伦理导师以及包括首席验尸官办公室和州生命统计中心在内的全州公共卫生资源的合作、研究基础设施和补充资金。研究部分是对全州范围内2岁以下儿童人口的前瞻性纵向研究，这些儿童遭受了任何类型的非穿透性脑损伤(TBI)，其严重程度足以需要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群的致命性脑损伤(ITBI)数据。这一系列拟议的研究建立在疾控中心赞助的一项研究(C.Runyan)中已经收集的数据、与公共卫生数据的联系以及这一应用程序特有的数据的基础上，这些数据将在受伤后一年和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将确定非创伤性脑损伤和创伤性脑损伤的发生率和病死率，以及比较两组之间的损伤模式和最初的临床表现。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果和非生物学数据。将探索非生物因素如何调节队列结果的模型。研究3将利用标准化的神经心理测试，利用家访来确定致命性和非致命性脑损伤儿童之间的认知和行为发育结果的差异。将收集关于儿童家庭的进一步信息，包括应对和家庭功能指数。该假说认为，患有创伤性脑损伤的儿童比非创伤性脑损伤的儿童情况更差，部分原因是损伤类型，部分原因是受伤后的家庭环境。将开发包含这三项研究的模型的初步数据。最后，研究4将描述创伤性脑损伤儿童最初和纵向的社会和法律影响。除了出版物外，这项有指导的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.