PENNSYLVANIA ABUSIVE HEAD TRAUMA PREVENTION PROGRAM

宾夕法尼亚州虐待性头部创伤预防计划

• 批准号: 7364483
• 负责人: MARK STEVEN DIAS
• 金额: $ 56.14万
• 依托单位: PENNSYLVANIA STATE UNIV HERSHEY MED CTR
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-30 至 2012-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7364483
• 关键词: PENNSYLVANIA; ABUSIVE; HEAD; TRAUMA; PREVENTION

DESCRIPTION (provided by applicant): Abusive head trauma (AHT) represents the most serious form of child abuse with a 13-30% mortality and significant neurological impairment in over half of survivors (1-6). The incidence of AHT is estimated to be 23-42 per 100,000 infants (7-10) with an average of approximately 30 per 100,000 infants. With a United States population of 300 million and a birth rate of 14.1 per 1000 population, this represents approximately 1250 cases annually in the United States. An effective primary prevention strategy that would reduce the incidence of AHT would potentially save the lives of many children and improve the lives of many others. The objective of this proposal is to test two simple, low cost interventions that have a high probability of success based upon our previous work. To evaluate these interventions, we will pursue the following four specific aims: Hypothesis #1: A hospital based post-natal primary prevention program directed to parents of all newborn infants in Pennsylvania will significantly reduce the incidence of AHT. Specific Aim #1: Assess the effectiveness of an established state-wide program of hospital based post-natal parent education about violent infant shaking, provided at a single consistent time point between the infant's birth and hospital discharge, in reducing the incidence of abusive head trauma (AHT). The principal investigator has recently established in Pennsylvania (PA) a statewide hospital based primary prevention program for AHT. Parents are provided written and video materials about violent infant shaking during the newborn period, and are asked to voluntarily sign commitment statements (CS) affirming their participation. The effectiveness of this strategy will be assessed by comparing the incidence of AHT cases reported to a statewide child abuse registry with both pre-intervention rates and with contemporaneous rates derived from the multi-state Kid Inpatient Database (KID). Additional embedded time series design and case cohort and sham cohort analyses will be used. Hypothesis #2: The 'Portrait of Promise' 8-minute video will be the most important mediator of the intervention effect; the intervention effect will be more due to changes in perpetrator rather than caregiver behavior; the intervention will be less effective among high risk families. Specific Aim #2: Identify which component(s) are the most important mediators of the intervention's effectiveness; determine whether the intervention effect is more directly related to changes in perpetrator or caregiver behavior; and determine the effectiveness of the intervention among various socioeconomic groups. The relative effectiveness of four program components (brochure, video, maternity ward posters, and discussion with the nurse educator) will be assessed by tracking exposure to the components on the CS. The frequency with which identified AHT cases are exposed to each component of the program will be contrasted with the corresponding exposure among a randomly selected cohort drawn from all PA births using a case cohort analysis. Whether the program changes perpetrator behavior or teaches parents to better select caregivers for their infant will be assessed by comparing reductions among various perpetrator groups and through post-natal parent surveys of parents' perceptions of the intervention in modifying behaviors. Finally, the relative effectiveness of this intervention among high and low risk families (as identified by four key demographic characteristics - parent age, educational attainment, marital status, and race/ethnic background - shown to be statistically associated with AHT in PA) will be compared.

描述（由申请人提供）：虐待性头部创伤（AHT）代表了最严重的虐待儿童形式，死亡率为13-30％，而超过一半的幸存者（1-6）代表了13-30％的死亡率和严重的神经系统障碍（1-6）。 AHT的发生率估计为每100,000名婴儿（7-10），平均每100,000名婴儿约30个。 美国人口为3亿，每1000人口的出生率为14.1，这每年约为1250例。 一种有效的主要预防策略将减少AHT的发生率，可能会挽救许多儿童的生命并改善许多其他孩子的生活。 该提案的目的是测试两种简单的低成本干预措施，这些干预措施根据我们以前的工作具有很高的成功可能性。 为了评估这些干预措施，我们将追求以下四个具体目标： 假设1：针对宾夕法尼亚州所有新生婴儿的父母的基于医院的产后预防计划将大大降低AHT的发生率。 具体目的＃1：评估基于医院后父母的既定全州范围内有关暴力婴儿摇晃的计划的有效性，该计划在婴儿的出生和住院分期之间的单个一致时间点提供，以减少虐待头部创伤的发生率（AHT）。 主要研究人员最近在宾夕法尼亚州（PA）建立了一项基于全州医院的AHT的初级预防计划。 提供父母的书面和视频材料，内容涉及新生儿时期的暴力婴儿，并被要求自愿签署承诺陈述（CS），以确认他们的参与。 该策略的有效性将通过将报告的AHT病例与全州虐待儿童注册机构与干预前率以及从多州KID KID住院数据库（KID）得出的同期率进行比较来评估。 将使用其他嵌入式时间序列设计以及案例队列和假手术队列分析。 假设2：“诺言肖像” 8分钟视频将是干预效果的最重要的调解人；干预效果将更多是由于肇事者而不是照顾者行为的变化。在高风险家庭中，干预措施的有效性较小。 特定目的＃2：确定哪些组成部分是干预效果的最重要的中介者；确定干预效应是否与肇事者或照料者行为的变化更直接相关；并确定各个社会经济群体之间干预的有效性。 将通过跟踪CS上的组件来评估四个程序组件（小册子，视频，孕妇病房海报以及与护士教育者的讨论）的相对有效性。 使用案例队列分析，将确定的AHT病例暴露于程序的每个组成部分将与从所有PA出生中抽出的随机选择中的相应暴露对比。 该计划是改变肇事者的行为还是教父母 为了更好地选择婴儿的护理人员，将通过比较各个肇事者群体的减少以及父母对父母对修改行为干预的看法的调查来评估。 最后，将比较高风险家庭中这种干预措施的相对有效性（如四个关键人口特征所确定的 - 父母年龄，教育程度，婚姻状况和种族/族裔背景 - 显示与PA中的AHT统计相关）。