Mount Sinai Injury Control Research Center (MS-ICRC)

摘要 西奈山伤害控制和研究中心(MS-ICRC)将在拟议的供资期间继续， 专注于改善创伤性脑损伤(TBI)后发生的第二和第三种情况， 解决两个目标：(1)改善脑外伤后的生活质量和(2)延长脑外伤后伤者的寿命 40岁。我们增加了一项额外的强调：减少青少年的暴力和犯罪行为 风险很高。 MS-ICRC的拟议研究方案包括：(1)调查行为的影响 对假释青年(有脑外伤和没有脑外伤)的暴力和累犯进行干预。本研究 “翻译”我们为成人脑损伤人群开发的干预措施，供有风险的青少年使用 它包括对患有脑外伤的青少年罪犯进行干预的第一项研究。(2)试点前景 对40岁后遭受脑外伤的人进行的队列研究，以记录健康问题和其他因素 可能导致脑外伤幸存者加速衰老和早熟死亡。(3) 分析了德克萨斯州少年司法系统开发的一个数据库，以探索两者之间的关系 TBI(和其他健康因素)和青少年犯罪，特别关注暴力犯罪。这项政策 在此之前，MS-ICRC对德克萨斯州的青少年司法系统进行了广泛的接触，导致 他们决定对其人群进行脑损伤筛查(使用MS-ICRC的脑损伤筛查问卷 [BISQ]))。(4)在纽约圣约翰大学建立所有大学生运动员的纵向数据库 在大学入学时记录脑震荡的终生病史，然后前瞻性地 记录在校期间在赛场内外所遭受的脑震荡。学生运动员将被跟踪到 定义脑震荡的长期后果。此项目将完全手动，以便在其他环境中复制 机构，朝着建立全国大学运动脑震荡登记的方向迈进。(5)A类 探索项目计划，以鼓励其他研究人员扩大他们的工作，以解决多发性硬化症- 红十字委员会的长期目标。项目1和项目3合计对全系统的发展具有很强的政策影响 及早发现患有脑损伤的儿童的干预措施并提供后续服务 容留，即系统干预，以减少青少年罪犯的暴力和犯罪行为，或学校- 以干预为基础的干预措施，以防止脑外伤儿童走上通常导致长期未治疗的道路 因伤害犯罪行为、无家可归和其他形式的社会失败而带来的挑战。 拟议的外联方案通过在我们当前活动成果的基础上实现MS-ICRC的目标 (2007-2012年)，随着新的“产品”的开发，将拟议活动的成果编织到外联活动中 对行动产生了新的影响。具体地说，三种干预措施(采用认知行为疗法 治疗脑外伤后抑郁，以及脑外伤后的执行加和STEP治疗计划 功能障碍)已经开发、评估和手册。计划中的外展将侧重于广泛的 传播和支持采用这些对脑损伤治疗武器库有价值的补充。一秒钟 目前的重点是通过进一步验证BISQ及其对BISQ的改编来筛查“隐性”脑损伤 基于Web的管理。未来五年的外展将强调更广泛地传播BISQ到屏幕 增加人口，目标是改变学校和其他环境中的政策 需要进行筛查，以确定有脑损伤相关挑战的个人，以便能够 提供以防止与无法识别的伤害相关的故障。另一个重点是工作 与营销专家一起，更好地定制MS-ICRC的外联活动，以满足我们几个选民的需求。一个 MS-红十字委员会外联的新内容将是一个政策智库，以审查基于MS-红十字委员会的证据 并从已建立的知识库中进行研究，进而详细阐述实现政策的手段和策略 改变；第一个领域将是建立对“隐性”脑损伤的系统筛查。 培训和教育方案将继续侧重于为外地提供合格的专业人员 伤害预防从业者和研究人员本着2007年建立的培训计划的精神。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, 我们将通过网络研讨会和研讨会、研讨会和专业人士讲座来教育服务提供商 会议和机构；我们还为专业人员提供大量资源，可在(免费)上下载 我们的网站。将课程改革纳入医学和其他专业课程的建议 还将开展专业培训。

ABSTRACT 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 study of an intervention for young offenders with TBI. (2) A pilot prospective cohort study of individuals 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.