In 1961, Dr. Robert Guthrie, a pediatrician and microbiologist,
developed a simple test, using a “heel-stick” drop of blood, to
detect phenylketonuria (PKU) in newborn infants. This rare, inherited
disease interferes with the body’s capacity to metabolize protein.
Unless treated almost immediately with a special diet, PKU
progressively derails a child’s intellectual development. Children
with untreated PKU may appear healthy as newborns, but by age 3 to
6 months, they begin to lose interest in their surroundings, and by
1 year of age, their intellectual function is irreversibly impaired.
Dr. Guthrie’s discovery has allowed for rapid, inexpensive screening
of all infants at birth. Those identified with PKU can be started on
the preventive diet and escape the disorder’s permanent damaging
effects. Building on Dr. Guthrie’s discovery, NIH-supported
scientists developed an additional newborn screening test, this
time for congenital hypothyroidism. Like PKU, this condition may not
be apparent at birth, but unless simple preventive treatment begins
almost immediately in affected infants, irreversible damage to the
developing brain occurs within months. All states now mandate newborn
PKU and hypothyroidism screening, and the developmental disability
associated with these two disorders has all but disappeared in the
United States.
Introduction
From before conception through old age, complex biological processes
interacting with physical and psychosocial factors in an environment
determine health and functioning at any given life stage and provide
the foundation of the next stage. NIH research in this area
encompasses the formation and development of cells, tissues,
organs and organ systems, as well as the physical, cognitive,
and behavioral characteristics of the child, adolescent, and
adult in his or her environment. Although developmental processes
proceed most rapidly in gestation and the early years of childhood,
they continue throughout the course of life.
This area of research includes studies of normative processes of
growth, maturation, and aging. Understanding “what goes right”
developmentally at each life stage is critical to discovering
how to protect and enhance human health and functioning. Knowledge
from such normative research also is essential to understanding the
role of developmental vulnerabilities in the origins, expression,
prevention, and treatment of illness and injury. For example,
understanding the normal brain immaturity of adolescents is
essential to understanding aberrant behaviors of youth and developing
interventions that will work for them. Similarly, understanding
normal, progressive maturation and functional decline in relation
to disease processes is key to discovering better interventions to
extend healthy active years of life. At all life stages, normative
data on physical and psychosocial development are critical to
designing effective rehabilitative interventions.
Individuals may experience underdeveloped, lost, damaged, or
deteriorated function during any of the life stages. Medical
rehabilitation research is the study of physiologic mechanisms,
methods of treatment, and devices that serve to improve, restore,
or replace these functions. This research includes translating new
knowledge into medical, behavioral, psychological, social, and
technological interventions to optimize impaired functioning. A
key aspect of medical rehabilitation research is its focus on the
effects of functional impairment on the whole person, rather than
on a single organ system. Thus, it views the person in the context
of a system of interacting variables, including psychosocial, organic,
and environmental.
By necessity, the scope of NIH research on life stages, human
development, and rehabilitation is broad. Dynamic, ongoing
interactions among developmental processes and physical and
psychosocial environmental factors are implicated in a wide
range of disorders and disabilities. Research in this area
includes basic, clinical, epidemiological, and translational
studies of normative processes and of many chronic diseases such
as cancer, obesity, osteoporosis, and cardiovascular and metabolic
disorders. Also included is research on mental illness, addiction, and cognitive disabilities such as intellectual
disability, autism, and Alzheimer's disease. Whereas the section
“Chronic Diseases and Organ Systems” in this report addresses
these conditions generally, this section focuses on life stage
and developmental dimensions of chronic and other conditions and
on rehabilitative interventions.
NIH Institutes dedicated to specific disorders and organ systems
incorporate life stages and developmental perspectives into their
research initiatives and projects. For example, NCI supports
research on how cancer risk and therapies may differ in children,
adults, and the elderly. Among NIDCR's research priorities are
studies of genetic and environmental interactions that may explain
disfiguring birth defects of the head, face, and mouth. NINR and
NIAAA strategic plans incorporate a life-course approach.
As the Institute with statutory responsibility for child health
and human development research, NICHD conducts and supports
research programs in reproductive health and the developmental
processes that begin before conception and continue through
gestation, birth, infancy, childhood, and adolescence. As the
Institute charged with research on aging, NIA conducts and supports
research on both the maintenance and loss of functions during the
aging process, diseases associated with aging, and the problems
and needs of older individuals and their caregivers. NINR conducts
research focused on establishing a scientific basis for patient
care across all life stages and is designated the lead NIH
Institute for end-of-life research. NIEHS focuses on the influences
of environmental agents on the development and progression of human
disease.
Mission-specific rehabilitation research is supported by 18
Institutes, including NIA, NIBIB, NICHD, NIDCR, and NINDS. A
focal point for this area is the National Center on Medical
Rehabilitation Research, within NICHD, which emphasizes the
rehabilitation and lifelong care of people with physical
disabilities resulting from injury, stroke, and other disorders.
Burden of Illness and Related Health Statistics
Because of the wide range of disorders studied in NIH life stages,
human development, and rehabilitation research, data on the health
and economic costs of specific conditions are presented throughout
this report. This section presents selected examples of general
data on lifetime burdens of illness and on burdens at the beginning
and later stages of life.
Lifetime Burden
From birth to death, per-person health care costs in the United
States have been estimated to average $316,579 in 2000 dollars.
Of this total, an estimated 7.8 percent of health care costs
accrue from birth to age 20, 12.5 percent between ages 20 and
39, 31.0 percent between ages 40 and 64, and 48.6 percent, or
almost half of all lifetime health care expenditures, after age
65.80 Between 1992 and 1996, 22 percent of all medical expenditures for the period after age 65
occurred in the last year of life.81
Although rates of self-reported disability in people age 65 and
older have been declining in recent years, any cost savings
from this trend may be offset by the burgeoning growth of this
population as a proportion of U.S. residents.82 Between 2000 and
2050, the proportion of this older population is expected to
increase from 5.9 percent to 11.6 percent of U.S. residents.
Early Origins of Disease and Disability
Preterm birth and the associated problem of low birth weight signal
the potential for significant developmental problems that may
originate in the prenatal period, or even before, as a result
of a family's genetic makeup and its environmental exposures.83
Preliminary data indicate that in 2004-2005, 12.7 percent of U.S.
births were preterm, a rate that has risen 20 percent since 1990.
Infants born with low birth weight in 2005 comprised 8.2 percent
of births, an increase of more than 20 percent since the mid-1980s.84
Although medical advances and supportive environments enable
increasing numbers of preterm infants to survive and to “catch up”
developmentally in childhood, the health and economic burdens
associated with these births begin immediately and may last a
lifetime. In 2001, costs for preterm, low-birth-weight hospital
admissions were $5.8 billion in the United States, or 47 percent
of the costs of all hospital stays of infants.85 Preterm birth
accounts for one of five children with intellectual disability,
one of three children with vision impairment, and almost half
of children with cerebral palsy. For an individual with
intellectual disability, lifetime costs of medical care, special
education, residential care, lost wages, and other associated
expenditures are estimated to be $1,014,000 in 2003 dollars.86
Later Emergence of Disease and Disability
Aging comprises a set of dynamic biological, physiological, and
psychosocial processes and systems that are interactive and
independent and that result in wide variations in health
outcomes and functioning. For some individuals, sensory,
cognitive, and physical capacities continue at remarkably
high levels for decades. For others, increasing age is accompanied
by a significant, progressive decline in almost all physiological
functions and a significantly increased risk of age-related chronic
diseases and disability. Recent estimates indicate that approximately
80 percent of all individuals in the United States who are 65 years or
older have at least one chronic condition, and 50 percent have at
least two.87
The marked variability among older adults in aging processes and disease
burden may be explained in part by risks incurred in earlier decades.
For example, periods of rapid tissue growth in gestation, early
childhood, adolescence, and during pregnancy may be periods of
heightened risk to later-emerging cancers.88 Low birth weight is
related to increased risk in adults for cardiovascular disease,
such as myocardial infarction, stroke, and hypertension.89
Maternal diabetes during pregnancy may increase the risk of
diabetes and obesity in offspring.90 Prenatal influences also
may increase risks of osteoporosis91 and Alzheimer's disease.92
In each case, discovering effective interventions at early
stages in life could contribute to lower burdens of disease
and disability associated with aging.
NIH Funding for Life Stages, Human Development, and Rehabilitation Research
In FYs 2006 and 2007, NIH funding for rehabilitation research
was $324 million and $344 million respectively. Currently, NIH
does not collect trans-NIH funding data on the category of life
stages and human development research. The table at the end of
this chapter indicates some of the research areas involved in
this investment (see “Estimates of Funding for Various Diseases,
Conditions, and Research Areas”).
Summary of NIH Activities
The goal of life stages, human development, and rehabilitation
research is to enable people to achieve a full lifespan with the
best health and function at every life stage. Understanding complex
developmental pathways to health or illness throughout life is
critical to creating new ways to prevent disease and disability
before they become symptomatic—or even preempting the disease
process before it starts. Developmental stages also are an important
consideration in rehabilitation research. For example, differences
between age groups such as physical size, physiological processes,
psychosocial trajectories, and expected lifespan must be taken into
account in planning rehabilitation for an individual. A central
goal of research is to provide the scientific evidence needed to
support developmentally appropriate rehabilitation plans.
The fundamental concepts of developmental science, such as
“developmental windows,” can be brought to bear whether a
research project focuses primarily on normative development,
multiple life stages, a specific life stage, or rehabilitation.
These “windows” are periods in the life of a cell, a fetus, a
child, or an adult when the normal processes of growth and
maturation may be more sensitive to the effects of external
factors, often referred to as “environmental influences.”
Because human development progresses in a multifaceted environment,
scientists study a wide range of external factors that could have
adverse or protective effects on human health and functioning.
This research might examine the effects of physical agents such
as, for example, diet, exercise, pesticides, industrial chemicals,
or mold. But it also might investigate the influences on health and
development of factors such as parenting styles, family structure,
education, community social norms and economic status, and/or
intergenerational influences.
Normative Research
Scientists' efforts to identify and understand interactions among
developmental processes and external factors are being accelerated
by powerful new technologies. For example, advanced imaging
technologies are being used to create a robust database of normal
brain development during childhood and adolescence. The resulting
data will enable scientists to better understand the atypical
developmental processes associated with autism, intellectual
disability, and other developmental disorders. Novel analytic
techniques developed in genomics research have created new
research opportunities in the emerging field of epigenetics.
This new field builds on discoveries that the timing of gene
functions—the “on” and “off” switches that control myriad
biological processes—can be altered without changing the structural
DNA “coding” of a gene. The health effects of these subtle and
potentially reversible alterations may be transient or may persist
and even be passed down from parent to child. One new NIH
initiative in developmental epigenetics focuses on alterations
in gene expression that may occur spontaneously or in response
to environmental exposures well before birth. Multiple initiatives,
comprising a Roadmap Epigenomics Initiative, are intended to
develop comprehensive reference maps of the epigenome and to
develop new analytic technologies.
In other normative research, a long-term study of women before,
during, and after menopause is designed to improve understanding
of the health effects, psychosocial influences, and subsequent
health consequences of this major life stage for women. Extended
studies of older populations are enabling scientists to
disentangle the effects of disease from the normal aging process.
Discoveries by NIH-supported scientists conducting normative
research have enabled them to preempt the development of cleft
palates in experimental mice that were bred to manifest this
disabling defect. Having identified a protein that influences
the development of certain undifferentiated cells in the embryo,
scientists then identified the critical point in normal embryonic
development of the palate, or roof of the mouth. They subsequently
manipulated the protein at that point in development to reverse the
initiation of the clefting process in the mice.
Multistage Research
NIH research encompassing multiple developmental or life stages
seeks to understand what factors early in life may contribute
to health or to health risks in later life (see also the section
“Epidemiological and Longitudinal Studies” in Chapter 3). This
conceptual model builds on seminal “life course” studies that
found clues to the origins of adult chronic diseases in the
earliest period of human life-gestation. The first life course
studies linked the risk of heart disease, stroke, hypertension,
and diabetes in adults to adaptation of the fetus to inadequate
nutrient supply in utero.93
NIH research examples in this section illustrate how the life-course
research model has expanded to include a greater number of
developmental stages and a wider array of potentially influential
environmental factors. For example, the National Children's Study
(NCS) is designed to enroll women who intend to become pregnant and
to follow their pregnancies and then their children from birth to
age 21. Investigators will use multiple techniques to examine many
aspects of the children's lives over time—from family genetics,
to the constructed environment of neighborhoods and schools, to
chemical exposures linked to the atmosphere, food, and water
supplies. The overall NCS goal is to understand the relationships
among multiple exposures and multiple health outcomes. NIH also is
collaborating with the Norwegian National Public Health Institute
in a long-term prospective cohort study of pregnant women and their
children, in which a variety of exposure and health variables will
be investigated.
Other studies encompassing more than one life or developmental
stage investigate specific factors and/or specific health outcomes.
For example, investigators within a consortium of NIH-supported
research centers study a range of prenatal to adult environmental
exposures that may predispose a woman to breast cancer.
NIH-supported scientists use longitudinal studies, imaging and
genetics tools, and animal studies to examine the contribution of
in utero drug exposure to emotional and cognitive development and
to vulnerability to later substance abuse and other mental disorders.
Research on the long-term safety of fetal and infant exposure to
anti-HIV (antiretroviral) drugs, administered to prevent HIV transmission
from an infected woman to her child, is one of numerous NIH research
efforts in HIV/AIDS. Cohorts of long-term cancer survivors, including
those treated in childhood and at other life stages, are being
followed to identify the health and developmental effects of cancer
drugs and radiation treatments. Known adverse effects include damage
to heart muscles; neurocognitive problems; reproductive health
problems, including infertility; pain; and second malignancies,
as well as anxiety and depression, discrimination in employment
and insurance, and general quality of life. This “survivorship”
research ultimately seeks to optimize physiological, psychosocial,
and functional outcomes for cancer survivors and their families.
Stage-Specific Research
NIH research that focuses on a single life stage seeks to
understand the developmental vulnerabilities of that stage
and their implications for risk of disease or disability and for
effective interventions. For example, sensitivity of the rapidly
developing fetus and the newborn to a variety of inborn and
external risk factors is the subject of extensive NIH-supported
research efforts. Included in this research are ongoing research
programs on stillbirth, preterm birth, SIDS, fetal alcohol
syndrome, and birth defects. In one study, scientists found that
preterm infants could go home earlier from neonatal intensive
care units if their parents received an educational and behavioral
intervention that began shortly after their child's admission to
the unit and continued after the child went home. During the
intervention, fathers as well as mothers learned about the appearance
and characteristics of preterm infants and how best to parent their
child. This research also found that the intervention lessened mothers'
anxiety, depression, and overall parenting stress and increased fathers'
involvement in infant care.
School-age children are an important research population because
habits that can protect an individual's health, or increase his or
her risk of later disease or disability, may be established in this
developmental period. Examples of this research include testing a
middle-school intervention to lower the risk of developing type 2
diabetes in children as they approach adolescence. Once considered
an “adult” disease, type 2 diabetes increasingly is seen in
children as rates of pediatric obesity continue to rise. To
investigate the potential of the school environment to promote
the adoption of long-term healthy behaviors, the experimental
program is testing the effects of offering healthier food choices
in school cafeterias and vending machines, lengthening and
intensifying periods of physical activity, and deploying
communication campaigns. In another example, scientists have
developed a large body of evidence about how children learn to
read and are now investigating differences in how children learn
math and science. Research into learning processes for children
both with and without learning disabilities permits the development
of evidence-based teaching methods so that children with a range of
abilities can learn these critical subjects. Major developmental
disabilities in children, including intellectual disability and
autism, also are the subject of ongoing research.
Adolescence, the developmental period in which the immature brain
and teenage social contexts may explain risk-taking behaviors, is
another focal point of life stages and human development research.
Carefully designed studies on teen and college-age substance-abusing
behaviors and teen driving are providing the scientific basis for
new interventions. Studies of the unique challenges in clinical
management of youth with HIV or at risk of infection, and of
pharmacological therapies for young people with depression and
suicide risk, are yielding important guidance for clinicians.
Models for delivering needed services to youth with mental
illness as they transition to adulthood are being tested.
Another significant area of stage-specific research encompasses
the period in which couples start families. Reproductive
health research includes expanding fundamental knowledge
of processes that underlie human reproduction, investigating ways
to alleviate human infertility, and developing and testing new
contraceptive options for men and women. Basic, clinical, and
translational studies aim to increase understanding of normal
reproduction and reproductive pathophysiology and to develop
more effective strategies for diagnosing, treating, and
preventing conditions that compromise reproductive health.
To advance research in this area, the NIH sponsors training
programs for reproductive health researchers, including
obstetricians and gynecologists.
As individuals age, interactions among normal aging processes and
risks acquired early in life and/or cumulatively over the course
of life may heighten their vulnerability to disease and disability.
For example, many conditions that emerge or worsen in aging
individuals are characterized by inflammation, which leads over
time to changes in cell tissue and organ structure and function.
These changes may contribute to frailty, independent of overt
disease, and also may increase susceptibility to, and rate of
progression in, chronic diseases. NIH-supported projects include
studies of vascular inflammation and neurotoxicity in the aging
brain and inflammatory response to loss of sleep. The breadth of
NIH research in aging processes is illustrated by an initiative on
the psychological mechanisms that guide economic decisions of older
people and the underlying neurobiological pathways of their
economic behaviors. End-of-life studies focusing on enhancing
communications among individuals, families, and clinicians and
on measuring care outcomes are intended to enable those involved
to better manage this experience. An NIH
state-of-the-science conference on end-of-life care and publication of conference
proceedings were designed to survey and assess recent advances
and to chart additional new directions for this area of research.
Rehabilitation Research
Rehabilitative interventions to enable individuals to gain or
recover functions lost to illness or injury may be needed at any
life stage. Research in this area recognizes the need for
specialized approaches for infants and children at the beginning
of the developmental span, for mature adults, and for older people
experiencing cumulative effects of normal aging processes and
chronic disease. For example, the decline in disability among
older people raises questions of whether and how this trend can
be maintained or even accelerated. Enabling older people to maintain
their health and independence for as long as possible is a major goal
of NIH-supported rehabilitation research. Among efforts to reach that
goal are projects that are developing and testing exercise and
motor-learning interventions for adults who have experienced stroke,
hip fracture, and other chronic debilitating diseases and conditions.
An important priority in this research is translating findings from
the clinical research setting into effective and accessible
rehabilitative programs based in communities.
In other rehabilitation research, NIH-supported scientists are
applying the newest technology to hasten recovery from and lessen
disabling effects of disease and injury. Multiple research projects
are focused on novel technologies to supplement or restore lost
nervous system functions. Examples include studies to develop
devices designed to restore the capacity of people with spinal
cord injuries to stand and to control bowel and bladder function.
Scientists also are investigating technologies to control
seizures as well as brain-machine interfaces to allow persons
with paralysis to control devices directly with their brains.
To improve rehabilitation for upper-limb paralysis, NIH is
supporting the development of robotic exoskeletons that could
ultimately provide therapies for stroke patients in their homes
and elsewhere. To expand the mobility of soldiers and others who
have lost limbs to injury, NIH-funded research includes studies
of a new “intelligent” artificial knee joint. Investigators also
are developing ways to implant an artificial limb directly onto
the bone of a residual limb, eliminating the need for irritation-
and infection-prone socket devices. Even more technologically
advanced options for replacing irretrievably injured body parts
may one day result from pioneering research in tissue regeneration.
Notable Examples of NIH Activity
Key for Bulleted Items:
|
E = Supported through Extramural research
I = Supported through Intramural research
O = Other (e.g., (policy, planning, and communication)
COE = Supported through a congressionally mandated Center of Excellence program
GPRA Goal = Concerns progress tracked under the Government Performance and Results Act
|
|
Normative Research
Developmental Epigenetics: This rapidly evolving area of
research examines how nonstructural changes in gene expression
during normal developmental processes can influence health outcomes
across the generations. NIH is expanding its research in this area
to help scientists learn how typical epigenetic changes and
variations occur at the molecular level, starting well before
birth. Understanding these epigenetic changes—how they are
inherited and passed on to subsequent generations and what
factors influence them—could hold the scientific key to
understanding and modifying certain factors that lead to a number
of diseases or conditions, from obesity to heart disease.
- This example also appears in Chapter 3: Molecular Biology
and Basic Sciences.
- (I) (NICHD)
Researchers Report Chemical Rescue of Cleft Palate in Mice:
A growing understanding of the multiple roles played by the enzyme
GSK3 has enabled scientists to realize that this protein molecule
has a role in determining the developmental fates of certain
undifferentiated cells in the embryo. A few years ago, this
realization led a team of scientists to develop a technique that
prompts small molecules directly to turn GSK3 on and/or off with
a high degree of precision at different stages of fetal development.
In the March 1 issue of the journal Nature, NIH-supported
scientists and their colleagues reported using this on-off technique
to determine the critical developmental period of the palate, or
roof of the mouth, in mice. Remarkably, the researchers showed
that, by turning GSK3 back on in pregnant mice during this key
developmental window, their embryos in most cases corrected their
developing cleft palates. As they reported, five out of nine mouse
pups had complete reversal of the developing cleft, and another
newborn had a partial rescue of the cleft. As the authors noted,
“New approaches to rescuing selected developmental defects
require detailed knowledge of timing and levels of protein
expression; our studies provide an improved method for defining
these experimental conditions in vivo.”
MRI Study of Normal Brain Development: Understanding healthy
brain development is essential to finding the causes of many
childhood disorders, including those related to intellectual
and developmental disabilities, mental illness, drug abuse, and
pediatric neurological diseases. NIH is creating the Nation's
first database of MRI measurements and analytical tools, as
well as clinical and behavioral data, to understand normal
brain development in approximately 500 children from across
the Nation. This large-scale longitudinal study uses several
state-of-the-art brain imaging technologies. The data will be
disseminated as a Web-based, user-friendly resource to the
scientific community.
Study of Normal Brain Development: The NIH Intramural
Research Program is conducting studies to explore brain development
with MRI in healthy children and adolescents. Recent studies have
addressed differences in brain structure related to risk for
Alzheimer's disease and sex differences in brain development
trajectories.
National Longitudinal Study of Adolescent Health (Add Health):
Several NIH Institutes are supporting this study, which integrates biomedical,
behavioral, and social science data to discover the pathways that lead to
health and/or disease in adulthood. The NIH initially funded Add Health in
1994 as a social science study of the causes of adolescent health problems
and health-related behaviors. As the cohort of adolescents has moved into
early adulthood, the study's focus has shifted to the environmental,
behavioral, and biological pathways that lead to the development of adult
chronic disease. The study initially incorporated measurements of social
environments—peer groups, families, schools, and neighborhoods—that could
affect health and also incorporated a sibling-pair design that facilitated
quantitative genetic studies. Most recently, in collaboration with other
Federal offices, NIH funded a new wave of interviews that will include the
collection of genetic data and biological markers of disease processes, as
well as basic social, individual, and behavioral data. The new design was
developed by a collaborative team representing the fields of epidemiology,
cardiology, psychology, sociology, behavioral genetics, nutrition,
biostatistics, anthropology, medicine, molecular virology, statistics,
and survey research.
- For more information, see http://www.cpc.unc.edu/addhealth
- (E) (NICHD, NCI, NCMHD, NIA, NIAID, NIDCD, NINR, NIAAA, NIDA, OAR, OBSSR, ORWH)
Study of Women's Health Across the Nation (SWAN):
The goal of SWAN is to characterize the biological processes,
health effects, psychosocial influences, and sequelae of the
pre- to peri- to postmenopausal transition in ethnically diverse
cohorts. Now in its 14th year, SWAN involves seven clinical field
sites supported by a central reproductive hormone laboratory, a
coordinating center, an advisory panel, and a repository of blood,
urine, and DNA specimens. Used in numerous studies, SWAN data have
resulted in important findings. For example, changes in bone
density occur from premenopause through late perimenopause;
premenopausal women have a significantly lower prevalence of
forgetfulness than do women at later menopausal stages; and a
high body mass index (BMI) is not only associated with insulin
resistance, which dramatically increases the risk of
cardiovascular disease, but also with different
menopausal hormonal patterns relative to normal BMI.
- (E) (NIA, NINR, NCCAM, NICHD, NIMH, ORWH)
Baltimore Longitudinal Study of Aging (BLSA):
In 2008, NIA will celebrate the 50th anniversary of
the BLSA, America's longest-running scientific study
of human aging. More than 1,400 men and women ranging
in age from the 20s to the 90s have been study
volunteers. The BLSA has generated significant
findings to elucidate the normal course of aging
and disentangle the effects of disease from the
normal aging process.
Health and Retirement Study (HRS):
The HRS is the leading source of combined data on the
health and financial circumstances of Americans over
age 50 and is a valuable resource to follow and predict
trends and help inform policies for an aging America.
Now in its 14th year, the study follows more than 20,000
people at 2-year intervals and provides researchers with
an invaluable, growing body of multidisciplinary data on
the older Americans' physical and mental health,
insurance coverage, finances, family support systems,
work status, and retirement planning. Managed under a
cooperative agreement between NIH and the University of
Michigan, the study was expanded in 2006 to include
additional key constructs in cognitive aging. A substudy
will provide the first estimates of cognitive
impairment and dementia based on nationally
representative data and validation of survey measures.
HRS staff will also assemble information on sample and
questionnaire design, computer-assisted interview
programming, interviewer performance, and data
dissemination to improve the quality of data collected
and provide an incentive for international partners to
follow a harmonized design that will maximize the
potential for cross-national behavioral and social
research on aging.
Life Stages Research
The National Children's Study (NCS): The NCS
promises to be one of the richest information resources
available for answering questions related to children's
health and development and will form the basis of child
health guidance, interventions, and policy for generations
to come. The landmark study will examine the effects of
environmental influences on the health and development
of more than 100,000 children across the United States,
following them from before birth until age 21. This
extensive research effort will examine factors ranging
from those in the natural and manmade environment to
basic biological, genetic, social, and cultural influences.
By studying children through their different phases of
growth and development, researchers will be better able
to understand the role of these factors in both health
and disease. Specifically, NCS will identify factors
underlying conditions ranging from prematurity to
developmental disabilities, asthma, autism, obesity,
and more. The study is led by a consortium of Federal
agencies, including NICHD and NIEHS, CDC, and the
Environmental Protection Agency.
Environmental Health of Mothers and Babies: the Norwegian Mother and Child Cohort Study:
NIH is participating in the Norwegian Mother and Child Cohort Study,
which provides a valuable opportunity to assess the role of
environmental exposures in the health of women and their children.
The Norwegian Mother and Child Cohort Study, or MoBa, (den norske
Mor and barn-undersØkelsen) is an ongoing, long-term, prospective
cohort study of 100,000 pregnant Norwegian women and their children.
In collaboration with the Norwegian National Public Health Institute
(NIPH), NIH is supporting the collection of additional biologic
specimens from the pregnant women. These specimens will be used
for the measurement of environmental exposures. A variety of exposure
and health variables on babies, mothers, and fathers are collected.
Records from the cohort study will also be linked to routine national
health registries.
The Role of Development in Drug Abuse Vulnerability: NIH
supports a number of longitudinal studies at various stages of
development, following cohorts over extended time frames.
Information is gathered on children's cognitive and emotional
development, as well as their vulnerability to addiction later
in life. These studies have been critical to estimate, for example,
the contribution of in utero drug exposure on emotional and
cognitive development, vulnerability to substance abuse, and
other mental disorders. This knowledge, together with animal
studies that provide complementary and validating information
while minimizing the confounding factors that are likely to play
a role in prenatal effects of drug exposure in humans, will help
us to mitigate the deleterious impact of substance abuse on the
developing fetus. With regard to later developmental stages, the
application of modern brain imaging technologies has generated
unprecedented structural and functional views of the dynamic
changes occurring in the developing brain (from childhood to
early adulthood). The discovery of these changes has been critical
to understanding the role of brain development in decision-making
processes and responses to stimuli, including early exposure to
drugs. Such studies have suggested, for example, that an
unbalanced communication between volitional control and emotional
circuits may explain some of the impulsive reactions typical of
adolescents, who tend to engage in risky behaviors and are at
heightened risk for developing addictions. Collectively, these
longitudinal studies, using new imaging and genetics tools,
promise a greatly enhanced ability to interpret the effects of
myriad environmental variables (e.g., quality of parenting, drug
exposure, socioeconomic status, and neighborhood characteristics)
on brain development and behavior.
Transdisciplinary Tobacco Use Research Centers: Multiple
Institutes at NIH are co-funding seven collaborative,
transdisciplinary centers to identify familial, early childhood,
and lifetime psychosocial pathways related to smoking initiation,
use, cessation, and patterns of dependence. Research on genetics
of addiction, physiological biomarkers, and the use of advanced
imaging techniques can lead to individualized and community
approaches for tobacco prevention and treatment. This model
demonstrates the feasibility and benefits of scientific
collaboration across disciplines and public-private partnerships.
The Centers for Transdisciplinary Research on Energetics and Cancer (TREC):These
centers foster collaboration among transdisciplinary teams of
scientists to accelerate progress toward reducing cancer incidence,
morbidity, and mortality associated with obesity, low physical
activity, and poor diet. The biology and genetics of the many
factors that influence diet, physical activity, and obesity across
the stages of life are applied to behavioral, sociocultural, and
environmental factors, and transdisciplinary training opportunities
are provided for scientists. The TREC initiative is interfacing with
a number of established NCI initiatives in the area of diet, physical
activity, and weight and is integrated with the NIH Obesity Research
Task Force Strategic Plan.
HIV/AIDS Epidemiological and Long-Term Cohort Studies,
Cohorts, and Networks: NIH supports epidemiological HIV
research through a wide range of studies, cohorts, and networks
that contributes to our understanding of risk factors that lead
to HIV transmission and disease progression. Established in 2005,
the International Epidemiologic Databases to Evaluate AIDS (IeDEA)
compiles data from NIH-funded international HIV research to answer
population-level questions about HIV variants and resistance, HIV
pathogenesis in different settings, success of antiretroviral
therapy, treatment history of HIV in different populations,
success of prevention strategies, and vaccines. The Pediatric
HIV/AIDS Cohort Study (PHACS) network, established in 2005,
addresses two critical pediatric HIV research questions: (1) the
long-term safety of fetal and infant exposure to prophylactic
antiretroviral chemotherapy and (2) the effects of perinatally
acquired HIV infection in adolescents. The Women's Interagency HIV
Study (WIHS) and the Multicenter AIDS Cohort Study (MACS) are the
two largest observational studies of HIV/AIDS in women and
homosexual or bisexual men, respectively, in the United States.
These studies exceed the scope of clinical care diagnostics and
laboratory analysis on both HIV-infected and, importantly,
HIV-negative controls, which allows for novel research on HIV
spread, how the disease progresses, and how it can best be treated.
The groups focus on contemporary questions such as the interactions
among HIV infection, aging, and long-term treatment;
cardiovascular disease; and host genetics and its influence on
susceptibility to infection, disease progression, and response
to therapy.
Childhood Cancer Survivors Study (CCSS): Although survival
rates from childhood cancers are encouraging, researchers have found
that these young survivors may particularly suffer from the late
effects of treatment. In 2006, CCSS researchers documented serious
long-term health issues in adults after radiation for childhood
cancers. These findings will change treatment regimen guidelines
for current childhood cancers and also have implications for
individuals from the study who are now adults. The Children's
Oncology Group (COG) has prepared a resource for physicians,
“Long-Term Follow-Up Guidelines for Survivors of Childhood,
Adolescent, and Young Adult Cancers.”
Long-Term Cancer Survivors Research Initiatives: The
population of cancer patients surviving more than 5 years
continues to grow across life stages, from children through
senior adults. These research initiatives focus on the physiological
and psychosocial effects of treatment and medical interventions to
promote positive outcomes in survivors and their families.
Important early findings suggest long latencies for treatment-related
effects, highlighting the need for extended follow up, early
identification, and intervention before complications become more
serious. Implications include the length and quality of survival
and the ongoing burden of illness and costs.
Developmental Windows of Vulnerability to Environmental Exposures: The Breast
Cancer and Environment Research Centers supported by NIH function as a consortium to
study the impact of prenatal to adult environmental exposures that may predispose a
woman to breast cancer. The centers bring together basic scientists, epidemiologists,
research translational units, and community advocates within and across the centers to
investigate mammary gland development in animals and young girls to determine vulnerability
to environmental agents that may influence breast cancer development in adulthood. The overall
goals of the BCERC are to develop public health messages to educate young girls and women
who are at high risk of breast cancer about the role of specific environmental stressors
in breast cancer and how to reduce exposures to those stressors. These public health
messages will be based on the integration of basic biological, toxicological, and
epidemiological data.
- For more information, see http://www.bcerc.org
- This example also appears in Chapter 2: Cancer.
- (E) (NIEHS, NCI)
Population Research: Given the Nation's increasing diversity
and changing demographics, it is critical to understand how trends
in areas such as immigration, fertility, marriage patterns, and
family formation affect the well-being of children and families.
NIH research in these areas allows policymakers and program planners
to better address public health needs. For instance:
- The Fragile Families and Child Well-Being Study follows
children born to unmarried parents to assess how economic
resources, father involvement, and parenting practices affect
children's development.
- The New Immigrant Survey follows the first nationally
representative sample of legal immigrants to the United States,
providing accurate data on legal immigrants' employment,
lifestyles, health, and schooling before and after entering
the country.
- The National Longitudinal Survey of Youth (1979 cohort)
continues to assess the work, educational, and family experiences
of a nationally representative cohort of young men and women
who were 14-22 years old when they were first studied in 1979. T
he study also follows children born to female participants up
through age 20, creating the opportunity to study
intergenerational influences on child development, health
behaviors, and educational attainment.
- For more information, see http://www.fragilefamilies.princeton.edu/index.asp
- For more information, see http://nis.princeton.edu/
- For more information, see http://www.bls.gov/nls/nlsy79ch.htm
- This example also appears in Chapter 3: Epidemiological and Longitudinal Studies.
- (E) (NICHD, NCI, NCMHD, NIA, NIAAA, NIAID, NIDA, NIDCD, NINR, OAR, OBSSR, ORWH)
Brain Disorders in the Developing World: Research Across the
Lifespan: Brain disorders are the leading contributor to years
lived with disability in all regions of the world, with the exception
of sub-Saharan Africa. This program boosts research in the developing
world on childhood disorders such as cerebral palsy and epilepsy,
on mental illnesses such as depression and schizophrenia, and on
degenerative disorders such as stroke and Alzheimer's disease.
Under this program, U.S. investigators and their foreign
collaborators are studying the neurocognitive consequences of
HIV/AIDS, the relationship between zinc nutrition and brain
development, and the neurological disorders stemming from treatable
infectious causes, such as cerebral malaria, cisticercosis, TB, and
bacterial sepsis.
- For more information, see http://www.fic.nih.gov/programs/research_grants/brain_disorder
- This example also appears in Chapter 2: Neuroscience and Disorders of the Nervous System.
- (E) (FIC, NEI, NIA, NIAAA, NICHD, NIDA, NIEHS, NIMH, NINDS, ODS)
Nonalcoholic Steatohepatitis (NASH) Clinical Research Network:
NASH is strongly associated with obesity and type 2 diabetes,
conditions that have increased dramatically in recent decades.
Network research addresses GPRA Goal SRO-4.3. The Network is
conducting a randomized clinical trial to evaluate the safety and
efficacy of the insulin-sensitizing drug pioglitazone or vitamin E
compared with placebo for the treatment of nondiabetic adults with
NASH. Also, in a separate trial in children, the network is comparing
the insulin-sensitizing drug metformin, vitamin E, and placebo in
treating nonalcoholic fatty liver disease.
Acute Liver Failure Study Groups: The adult and pediatric
Acute Liver Failure Study Groups address the problem of acute liver
failure due to drugs or other factors. The Groups' research has
provided knowledge and tools for managing the clinical and public
health burden of acute liver failure. In 2002, the adult study group
highlighted a dramatic increase in liver injury due to the
over-the-counter pain reliever acetaminophen. The groups then
developed a serum-based assay to detect acetaminophen-induced acute
liver failure in adults and children. Current studies are testing
potential therapies to improve survival in patients with acute liver
failure.
Comprehensive Assessment of Long-Term Effects of Reducing Intake of Energy (CALERIE): A
large body of research in animals indicates that substantially
reducing caloric intake while maintaining optimal nutrition results
in significant increase in lifespan. The CALERIE study will help to
determine whether these beneficial effects extend to humans. Results
from pilot studies demonstrate that overweight people who cut their
calories by 25 percent for 6 months have reduced fasting insulin
levels and core body temperature, two markers that may be associated
with increased longevity in humans. A long-term study began in
January 2007.
Stage-Specific Research
Fertility and Infertility: As the CDC has stated, “for many
couples who wish to start a family, the dream is not easily realized.”
For about 2.1 million married couples who reported not using
contraception, the women were still unable to become pregnant
after 1 year. NIH supports research to better understand the basic
processes underlying human reproduction and to directly alleviate
infertility and reproductive disorders. Much of this effort
involves translating rapidly emerging laboratory research into
clinical applications. Scientists are working to determine how
certain gynecological conditions, such as polycystic ovary syndrome
and endometriosis, and certain diseases and disorders of the male
reproductive system affect fertility. Some evolving and exciting
fertility research is applying cryopreservation technology to
the freezing of human eggs to preserve fertility in women
undergoing cancer treatment. Scientists are also exploring the
link between obesity and fertility and assessing the long-term
impact of using assistive reproductive technologies.
Women's Reproductive Health Research Career Development Program:
The ORWH cosponsored with NICHD the funding of 20 institutional career
development awards designed to increase the number of obstetricians
and gynecologists conducting research in women's health.
Pregnancy and Perinatology: NIH continues to support a
portfolio of research on high-risk pregnancies and poor pregnancy
outcomes, including preterm labor and birth, fetal disorders, SIDS,
poor maternal health, and stillbirth. Much of this research is
conducted through centers and networks that bring together
researchers from different disciplines and allow them to study
larger numbers of patients. For example, NIH recently created two
research networks on premature birth and on stillbirth. The Genomic
and Proteomic Network for Premature Birth Research aims to accelerate
research in the area of premature birth by providing researchers
with the latest technology and methods. The Stillbirth Collaborative
Research Network aims to identify the causes of stillbirth so that
new interventions can be developed to prevent these tragic outcomes.
Prenatal Alcohol, SIDS, and Stillbirth (PASS) Research Network:
After a 3-year feasibility study, NIH established this
multidisciplinary consortium to determine the role of prenatal
alcohol exposure and other maternal risk factors in the incidence
and etiology of SIDS, stillbirth, and fetal alcohol syndrome, all
of which are devastating pregnancy outcomes. The PASS study will
follow 12,000 pregnant, high-risk, American Indian and South
African women and their infants prospectively until the infants
are 12 months old. Maternal, fetal, and infant measures and tissues
will be obtained for analysis.
Potential Therapy for Children Afflicted with Progeria Syndrome: :
Hutchinson-Gilford Progeria Syndrome (HGPS) is a genetic disorder of
accelerated aging. In addition to other symptoms of aging, HGPS
patients suffer from accelerated cardiovascular disease and often
die in their teen or even preteen years from heart-related
illnesses. No treatments are currently available for HGPS;
however, recent work led by NHGRI researchers indicates
that farnesyltransferase inhibitors (FTIs), a class of drugs
originally developed to treat cancer by blocking the growth
of tumor cells, are capable of reversing the effects of the
defective HGPS protein, lamin A. Ongoing studies in a mouse
model have validated the results of preliminary experiments,
and a clinical trial of FTIs in children with progeria began
in 2007. In FY 2008, researchers plan on expanding the study
to investigate whether FTIs are capable of reversing the
detrimental effects after progression of the cardiovascular
anomalies that are seen in the mouse model. The development
of biological assays to assess the effects of FTI treatment
on the patients' cells is in progress to monitor the
potential beneficial effects of the clinical trial. In
addition, it has been demonstrated that the progerin
protein is present in small amounts in normal aging tissues.
The investigation of this phenomenon is being pursued as
a contributory factor to the normal aging process.
Newborn Screening: Screening and treating newborns for
phenylketonuria (PKU) and hypothyroidism have virtually eliminated
these conditions as a cause of mental retardation in the United States.
A new, trans-NIH collaborative effort will build on this success to
develop a new generation of microchips and related technologies
that should enable screening programs across the Nation to rapidly
test newborns for hundreds of genetic conditions in a single test
using one drop of an infant's blood. Complementing the technology
development is an initiative to stimulate development of new
treatments for such conditions as short chain Acyl CoA dehydrogenase
deficiency (SCAD), tyrosinemia, and the genetic causes of hearing
loss with the promise of significantly reducing the lifelong health
burden of these and other conditions.
- This example also appears in Chapter 3: Technology Development
- (E) (NICHD, NIDCD, NIDDK)
Discovering the Causes of Nonsyndromic Cleft Lip and Cleft Palate:
For nearly 60 years, NIH has supported scientific investigation of
causes and interventions for cleft lip and cleft palate, which are
among the most common birth defects. In recent years, advances in
technology made it possible for scientists to directly sequence genes
suspected of contributing to cleft lip and/or palate. NIH grantees
and their associates have used this approach to identify genetic
mutations accounting for up to 13 percent of cases of cleft lip
and/or palate. One of the most recent advances occurred in March
2007, when the scientists reported sequencing the coding regions
of 12 members of the fibroblast growth factor (FGF) and FGF receptor
gene families and finding seven mutations that may contribute to as
much as 5 percent of nonsyndromic cleft lip and/or palate. The group
followed up by generating three-dimensional computer models of the
FGF proteins that predicted how the altered amino acids would affect
their normal shape and function. In a separate finding, NIH-supported
scientists reported that women who carry a fetus whose DNA lacks both
copies of a gene involved in detoxifying cigarette smoke substantially
increase their baby's chances of being born with a cleft lip and/or
palate if they smoke. About a quarter of babies of European ancestry
and up to 60 percent of those of Asian ancestry lack both copies of
the gene, called GSTT1. The scientists calculated that if a pregnant
woman smokes 15 cigarettes or more per day, the chances of her
GSTT1-lacking fetus developing a cleft increase by nearly
20-fold. Globally, about 12 million women each year smoke through
their pregnancies. This finding provides additional motivation
for expectant mothers to follow existing advice not to smoke.
Other work conducted by NIH scientists looking at occupational
exposures of parents suggest that exposures in certain occupations
may influence the risk of orofacial clefting in offspring.
Specific exposures accompanying these occupations warrant
exploration.
Craniofacial Birth Defects or Syndromes: Craniofacial defects
are among the most common of all birth defects. Birth defects and
developmental disorders can be isolated or may be part of complex
hereditary diseases or syndromes. Cleft lip and cleft palate are
among the more common birth defects in the United States, occurring
in about 1 to 2 of 1,000 births. Numerous other disorders with oral
and craniofacial manifestations, such as ectodermal dysplasias,
Treacher Collins syndrome, and Apert's syndrome, though considerably
more rare than cleft lip and cleft palate, also have serious lifetime
functional, esthetic, and social consequences. These disorders are
often devastating to parents and children alike. Surgery, dental
care, psychological counseling, and rehabilitation may help
ameliorate the problems, but often at a great cost and over many
years. In fact, the lifetime cost of treating the children born
each year with cleft lip or cleft palate is estimated to be $697
million. NIH is actively pursuing knowledge to prevent future
defects as well as treat those who are currently affected. Exciting
advances in genetic studies are shedding light on the genes that are
important in forming the head and face, how these genes function,
and how they interact with environmental, nutritional, and behavioral
factors. Such information may ultimately provide the knowledge
necessary for prenatal diagnosis, the development of methods to
prevent craniofacial birth defects, and the basis for developing
better treatments. The development of biocompatible, naturally
derived materials and biodegradable scaffolds offers new hope for
the treatment of defects resulting from craniofacial birth defects
or syndromes.
Understanding the Causes and Conceiving New Treatments for
Craniosynostosis: Craniosynostosis arises when one or more
of the fibrous sutures between the six cranial bones prematurely
fuse and lock sections of the skull tightly into place. Because
the brain continues to grow during early childhood, craniosynostosis,
if left untreated, can distort the shape of the skull and portions
of the face, as well as cause hearing loss, blindness, and/or
intellectual disability. To better understand the causes of
craniosynostosis, a team of NIH-supported researchers study the
fusion of cranial sutures in mice. They suspect that the premature
fusion involves alterations in the normal biochemical interplay
between embryonic tissue, called mesenchyme, from which the cranial
sutures form, and a thin fibrous layer of tissue, called the dura
mater, that lies beneath it. The scientists also have found that
different regions of the dura mater send different developmental
signals to the overlying mesenchyme. Defining in fine detail the
signals between the mesenchyme and the dura mater could provide the
intellectual basis for discovering and developing noninvasive
biological approaches to control craniosynostosis. NIH-supported
researchers have made an important step in this direction. They
isolated mesenchymal cells derived from cranial sutures in two
different areas of the skull, cultured each group of cells separately,
and later analyzed their gene expression patterns. The scientists
found clear differences in the patterns of genes expressed among the
two populations of mesenchymal cells. To their knowledge, this marks
the first glimpse of the genetic programs that are wired into
mesenchymal cells derived from cranial sutures. This line of research
potentially opens a new chapter in understanding the causes of and
conceiving new treatments for cranial synostosis.
Cesarean Delivery Versus Vaginal Birth: The rate of cesarean
delivery has risen dramatically over the past two decades; in fact,
cesarean delivery currently ranks as the most commonly performed
surgical procedure in the United States. More research is needed
to determine how frequently cesarean deliveries are scheduled for
women without medical indications for the procedure, and how these
“maternal request” deliveries compare with vaginal delivery in terms
of child and maternal health outcomes. Currently, NIH is supporting
a Cesarean Registry through the Maternal-Fetal Medicine Units Network.
Among other findings, the registry data showed that women who gave
birth to a child vaginally, after a previous cesarean delivery of
twins or triplets, were not at higher risk for complications during
labor and delivery.
- NIH Consens State Sci Statements. 2006;23:1-29, PMID: 17308552
- Varner M for the NICHD MFMU Network, The MFMU Cesarean Registry: VBAC success and complication rates following one previous cesarean for multifetal gestation. Abstract for the Society for Maternal-Fetal Medicine Annual Meeting 2006.
- (E) (NICHD)
Maternal Oral Health and Obstetric Outcomes: In recent years,
evidence has suggested that a pregnant woman with periodontal (gum)
disease might be at increased risk for premature birth. Two similar
but not identical NIH-supported trials evaluate this possibility.
Conducting more than one large clinical trial on this important
public health question will cast a wide enough investigational net
to determine which, if any, women are at risk. One study, called
the Obstetrics and Periodontal Therapy Trial (OPT), recently
concluded that periodontal treatment during pregnancy is safe for
mother and baby but does not significantly lower preterm birth
risk. The Maternal Oral Therapy to Reduce Obstetric Risk (MOTOR)
study is ongoing.
Study Shows Child's Weight Can Be Influenced by Mother Before and During Pregnancy:
NIH-supported researchers found that a child's weight may be influenced
by its mother even before the child is born. In a study of more than
3,000 children, scientists found that children of mothers who were
obese before pregnancy were more likely to be overweight by 3 years
of age. In addition, children born to African American or Hispanic
mothers or to mothers who smoked during pregnancy were at greater
risk for becoming overweight. These findings indicate the need to
develop creative and effective strategies to promote healthy
nutritional habits in prospective mothers as a way of reducing later
health problems in their children.
NICU Program Reduces Premature Infants' Length of Stay and Improves Parents' Mental Health Outcomes:
In a randomized, controlled clinical trial, NIH-funded investigators
tested an educational program, called Creating Opportunities for
Parental Empowerment (COPE), among parents of premature infants.
An estimated half a million premature infants are born in the
United States each year. Most require hospitalization in a newborn
intensive care unit, and their parents often suffer high levels of
stress, anxiety, and depression. Compared with controls, parents who
participated in the COPE program reported better understanding of
the behaviors to expect from their infants and displayed more
positive parent-infant interactions. Mothers had lower anxiety,
depression, and overall parenting stress, and fathers were more
involved in the infants' care. Infants of COPE parents averaged
3.8 fewer days in the neonatal intensive care unit than the control
infants, which translated to a savings of roughly $5,000 per infant.
Trial to Reduce the Incidence of Type 1 Diabetes for Those Genetically at Risk (TRIGR):
Researchers are conducting a study to determine whether the onset of
type 1 diabetes mellitus can be delayed or prevented by weaning
genetically susceptible infants to Nutramigen®, a hydrolysate of
cow milk protein, instead of to a standard cow milk-based infant
formula. Earlier studies in animal models have shown that hydrolyzed
protein diets prevented the onset of type 1 diabetes. TRIGR is the
first large effort designed to ascertain whether a simple nutritional
intervention during infancy can delay or prevent the onset of type
1 diabetes in children who are at high genetic risk for the disease.
Enrollment for the study was recently completed, totaling more than
2,000 children from 15 countries.
- For more information, see http://www.nichd.nih.gov/research/supported/TRIGR.cfm
- This example also appears in Chapter 2: Chronic Diseases and Organ Systems.
- (E) (NICHD; NIDDK administers the contribution from the special statutory funding program for type 1 diabetes)
Childhood and Maternal Obesity: As the maternal and childhood
obesity epidemic grows, researchers are trying to understand the
interaction among the many complex biological and behavioral
factors that contribute to this rise, identify the long-term
impact on mother and child, and develop effective interventions
to reverse these trends. NIH obesity research, which includes
a range of racial and ethnic groups, is examining topics such as:
- Basic research on the physiology, psychology, and genetics of obesity in children
- Developing working definitions of the metabolic syndrome in children and adolescents
- Linking maternal obesity, reproductive health, and pregnancy to adverse health outcomes
- Behavioral intervention trials in schools, the home, and the community
- This example also appears in Chapter 2: Chronic Diseases and Organ Systems.
- (E, I) (NICHD, NCCAM, NCI, NCMHD, NHLBI, NIDCR, NIDDK, NINR, OBSSR, ODP)
Diabetes Research in Children Network (DirecNet): The risk of
hypoglycemia is now the main obstacle to successfully managing type
1 diabetes mellitus in children of all ages. Severe hypoglycemia can
lead to seizures or unconsciousness. In 2001, NIH established
DirecNet to assess the accuracy and efficacy of continuous glucose
monitoring devices, evaluate the effectiveness of the devices as
tools to help control blood sugar levels, and determine the incidence
of hypoglycemia. DirecNet also focuses on possible changes in
neurocognitive function in children with type 1 diabetes who have
frequent bouts of hypoglycemia. The network was recently renewed to
use new tools to evaluate factors and mechanisms contributing to
hypoglycemia, such as exercise and diet. The goal is to continue to
improve management of type 1 diabetes and prevent hypoglycemia by
“closing the loop” between measuring glucose levels and delivering
insulin.
HEALTHY: The HEALTHY multicenter clinical trial aims to
prevent risk factors for type 2 diabetes in middle-school children.
A pilot study for HEALTHY found that an alarmingly high 15 percent
of students in middle schools enrolling mainly minority youth had
three major risk factors for diabetes; about half of the children
were overweight. These data suggest that middle schools are
appropriate targets for efforts to decrease risk for obesity and
diabetes. In the full-scale HEALTHY trial, 42 enrolled middle schools
receive the intervention, which includes changes to school food
service and physical education classes, behavior change, and
communications campaigns. More than 80 percent of the enrolled
students are from minority populations.
Studies of Diabetes in Youth: Previously known as a disease of adults,
type 2 diabetes is increasingly being observed in youth. The Treatment
Options for Type 2 Diabetes in Youth study is comparing three different
treatment strategies for children with the disease. The SEARCH for Diabetes
in Youth Study is providing key data on childhood diabetes incidence and
prevalence. SEARCH estimated that 1 of every 523 youths had
physician-diagnosed diabetes in 2001. Although type 2 diabetes is increasing
in children over 10, particularly minorities, type 1 diabetes accounts for
most new cases, with an estimated 15,000 youths diagnosed annually.
The Environmental Determinants of Diabetes in the Young:
Understanding the environmental factors, such as infectious agents
or diet, that can trigger type 1 diabetes in genetically susceptible
individuals is crucial to developing prevention strategies. To
address this knowledge gap, NIH established The Environmental
Determinants of Diabetes in the Young (TEDDY) consortium. This
international consortium is enrolling newborns and following them
until age 15 to identify environmental triggers for type 1 diabetes.
The study is amassing the largest set of data and samples in the
world for newborns at risk for type 1 diabetes.
- For more information, seehttp://teddy.epi.usf.edu
- This information also appears in Chapter 3: Epidemiological and Longitudinal Studies.
- (E) (NIDDK, NIAID, NIEHS, CDC, and the Juvenile Diabetes Research Foundation)
Longitudinal Assessment of Bariatric Surgery (LABS):
The multicenter, NIH-funded LABS consortium is analyzing the risks
and benefits of bariatric surgery as a treatment for extreme obesity
in adults. Because bariatric surgery is also sometimes used in
clinical practice as a treatment for severely obese adolescents,
NIH is also supporting an observational study of teens already
scheduled for surgery, Teen-LABS, to collect data to help determine
whether it is an appropriate treatment option for extremely obese
adolescents.
Bone Health: NIH researchers established reference curves for
bone mineral content and density in children. The early findings are
now available according to age, sex, and race and can be used to help
identify children with bone deficits and to monitor changes in bone
in response to chronic diseases or therapies. Early study findings
showed that bone minerals continue to accrue beyond the teenage years,
so the study will continue as the adolescent participants approach
young adulthood. In another study, NIH scientists discovered two
genes for osteogenesis imperfecta, or brittle bone disease. The
genes affect how collagen, an important building block for bone,
is formed. Although there is no treatment for the disorder, the
findings allow researchers to test families who have lost a child
to osteogenesis imperfecta for the presence of the defective genes.
Never Too Early—The Milk Matters Campaign: The risk for
osteoporosis actually starts in childhood. Thus, NIH supports a
public health campaign to help increase calcium consumption among
children and teens, ages 11 to 15, a time of critical bone growth.
Milk Matters is designed to educate parents, teachers, and health
care providers about how most tweens and teens are not getting
enough calcium their diets. The campaign features materials and
publications in English and Spanish.
- For more information, see http://www.nichd.nih.gov/milk/milk.cfm
- This example also appears in Chapter 3: Health Communication and Information Campaigns and Clearinghouses.
- (E) (NICHD, NIDCR)
Learning Math and Science: Educators, university leaders,
and scientists have called for evidence-based interventions to
improve U.S. students' understanding and achievement in mathematics
and science. NIH's long-standing research efforts on individual
differences in learning, how children learn to read, and
specific learning disabilities enable it to play a leading role
in improving understanding and developing these interventions.
For example, NIH Mathematics and Science Cognition and Learning
program supports both basic and intervention research in all
aspects of mathematical thinking and problem solving, as well
as in scientific reasoning, learning, and discovery. In
partnership with the Department of Education, NIH participates
in a national mathematics and science initiative and advises
on the best use of scientifically based research on teaching
and learning these critical subjects.
Intellectual and Developmental Disabilities: Intellectual and
developmental disabilities have serious, lifelong effects on
cognitive and adaptive development. NIH supports research to
improve functioning for individuals who have intellectual and
development disabilities and to understand the underlying genetic
processes to prevent these conditions. For example, NIH supports
14 Mental Retardation/Developmental Disabilities Research Centers
to advance diagnosis, prevention, treatment, and amelioration of
intellectual and developmental disabilities. Because the centers
have developed core research resources in genetics, proteomics,
and clinical infrastructure, they also provide support for
researchers in the Fragile X Syndrome Research Centers, Rare
Disease Cooperative Centers, and Autism Centers. In addition to
these centers, NIH supports research to better understand the
neurobiology and genetics that underlie the cognitive and behavioral
processes in persons with Down's syndrome and other intellectual
and developmental disabilities.
National Database for Autism Research (NDAR): The NDAR is a
collaborative biomedical informatics system being created by NIH to
provide a national resource to support and accelerate research in
autism.
- For more information, see http://ndar.nih.gov
- This example also appears in Chapter 2: Neuroscience and Disorders of the Nervous System and Chapter 3: Disease Registries, Databases, and Biomedical Information Systems.
- (I, E) (NIMH, NICHD, NINDS, NIEHS, NIDCD, CIT)
Teen Driving: Over one-third of teenage deaths are due to
motor vehicle accidents. NIH-supported researchers recently
completed a study demonstrating that teen drivers' behavior
often became more risky in the presence of teen passengers.
The researchers found that teenage drivers—both males and
females—were more likely to tailgate and exceed the speed limit
if there was a teenage male passenger in the front seat.
Conversely, male teenagers were less likely to tailgate or
exceed the speed limit when a teenage female was in the front
passenger seat. To determine why the presence of teen passengers
influenced these behaviors, NIH researchers are designing a study
that will involve placing electronic monitoring equipment in
vehicles with teen drivers. After learning the specific reasons
for the risky behavior, researchers can then work to develop
ways to prevent it.
Underage Drinking Research Initiative: In 2004, NIH launched
this ongoing initiative with the goal of obtaining a more complete
and integrated scientific understanding of the environmental,
biobehavioral, and genetic factors that promote initiation,
maintenance, and acceleration of alcohol use among youth, as
well as factors that influence the progression to harmful use,
abuse, and dependence, all framed within the context of overall
development. Activities and achievements in 2007 include:
- Provided the scientific foundation for The Surgeon
General's Call to Action to Prevent and Reduce Underage
Drinking (released March 6, 2007) and for the ongoing
work of the Interagency Coordinating Committee on Preventing Underage Drinking
- Convened scientific meetings of experts, including
the Underage Steering Committee, which met four times
over a 2-year period; a Meeting on Diagnosis of Alcohol
Use Disorders among Youth (April 2006); and a Meeting
on Screening for Child and Adolescent Drinking and
AUDs among Youth (June 2007)
- Issued three RFAs, including “Underage Drinking:
Building Health Care System Responses” (four projects
awarded in FY 2006), “Impact of Adolescent Drinking
on the Developing Brain” (five projects awarded in FY 2007),
and “Alcohol, Puberty and Adolescent Brain Development”
(three projects awarded in FY 2007)
- Published Alcohol Research and Health, Volume 28, Number 3,
“Alcohol and Development in Youth: A Multidisciplinary Overview”
- Published a supplement of seven developmentally
focused papers covering a broad range of underage
drinking topics (accepted for the journal Pediatrics).
The Rapid Response Program: In April 2002, the Task Force on
College Drinking released its seminal report, “A Call to Action:
Changing the Culture of Drinking at U.S. Colleges.” As part of its
college focus, NIH initiated support of collaborations between
university personnel who have responsibility for alcohol programs
on various campuses and established college drinking researchers
to implement and evaluate programs to reduce underage alcohol use
and its consequences. These programs include:
- RFA AA-03-008: “Research Partnership Awards for Rapid
Response to College Drinking Problems.” Five U01 (cooperative
agreement) 5-year grants were awarded in December 2002.
- PAR-03-133: “Rapid Response to College Drinking Problems.
” Fifteen 3- year grants were awarded in June 2003. This
rapid funding mechanism (U18, cooperative agreement)
supports timely research on interventions to prevent or
reduce alcohol-related problems among college students.
It was intended to support studies of services or
interventions that could capitalize on “natural experiments”
(e.g., unanticipated adverse events, policy changes, new media
campaigns, campus-community coalitions, etc.). Each U18 grantee
was required to partner with a U01 grantee. Together, these
pairs, working with NIH Scientific Staff Collaborators,
jointly design, develop, implement, and evaluate college
drinking projects on their campuses.
- This example also appears in Chapter 3: Epidemiological and Longitudinal Studies.
- (E) (NIAAA)
Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN):
Although one-third to one-half of new HIV infections occur among adolescents
and young adults, researchers know little about how the complex physiological
changes associated with adolescence impact the transmission dynamics and
course of HIV infection. NIH is supporting a national clinical research
network to address the unique challenges and clinical management needs
of HIV-positive youth and those at risk of infection. Researchers in
this network are building the capacity to develop and conduct selected
biomedical, behavioral, and community-based studies, including vaccine
and microbicide trials to ensure that the needs of high-risk teens are
considered as treatment and prevention interventions are being developed.
- For more information, see http://www.atnonline.org
- This example also appears in Chapter 2: Infectious Diseases and Biodefense.
- (E) (NICHD, NIDA, NIMH)
Adolescent Depression and Suicide: NIH continues to support
research on the treatment of depression during adolescence, including
the concern that certain antidepressant medications, called selective
serotonin reuptake inhibitors, can increase the risk of suicide.
NIH supported a recent meta-analysis of studies on this subject
that found that the benefits of antidepressant medication for
children and adolescents with major depressive disorder and anxiety
disorders likely outweighed any potential risks.
Interventions and Services for Youth with Mental Illness Who Are
Transitioning to Adulthood: The transition to adulthood for youth
with mental illness is often a period in which care is compromised,
with a host of negative outcomes. In 2006, NIH launched an initiative
to stimulate research on refining and testing interventions in
service delivery models for youth transitioning to adulthood. Four
applications were funded.
Alzheimer's Disease Neuroimaging Initiative (ADNI): ADNI is an
innovative public-private partnership for examining the potential for
serial MRI, PET, or other biomarkers to measure earlier and with
greater sensitivity the development and progression of mild cognitive
impairment and Alzheimer's disease. Early results suggest that
researchers may be able to reduce the costs associated with clinical
trials by improving imaging and biomarker analysis. One ADNI study
found that a standard model can be used to monitor the performance
of MRI scanners at multiple clinical sites, ensuring the accuracy
of the MRI images. In another study, investigators compared changes
over time in PET scans of brain glucose metabolism in people with
normal cognition, mild cognitive impairment, and Alzheimer's disease
and found that scans correlated with symptoms of each condition and
that images were consistent across sites, suggesting the validity of
PET scans for monitoring the effectiveness of therapies in future
clinical trials. More than 200 researchers have already accessed a
public database containing thousands of brain images and related
clinical data obtained through blood and cerebrospinal fluid
analyses.
Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE):
This recent multicenter study in community-dwelling seniors showed that
certain mental exercises can offset expected declines in thinking skills
of older adults and show promise for maintaining the cognitive abilities
needed for tasks such as shopping, making meals, and handling finances.
The ACTIVE study is the first randomized, controlled trial to demonstrate
long-lasting, positive effects of brief cognitive training in older adults.
Although training did not improve the participants' ability to tackle other
everyday tasks, their cognitive skills declined less than with untrained
seniors. Additional research is needed to translate these findings
from the laboratory into interventions that prove effective at home.
Lifestyle Interventions and Independence for Elders: Results
of several studies have suggested that physical exercise may prevent
physical disability, including impaired mobility, in both healthy and
frail older adults. To develop definitive evidence regarding the
effectiveness of such interventions, NIH designed the Lifestyle
Interventions and Independence for Elders (LIFE-P) pilot study, a
clinical trial that tested the effects of a physical activity
program versus a health education program in preventing major
disability. The study involved 424 participants age 70 to 89 who
were at risk of disability. These individuals were followed for at
least 1 year at four locations around the country: Wake Forest
University School of Medicine in Winston Salem, North Carolina;
the University of Pittsburgh in Pennsylvania; the Cooper Institute
in Dallas, Texas; and Stanford University in Palo Alto, California.
At various points in the physical exercise intervention, study
participants were tested for their performance on a battery of
lower-extremity function tests and the time required for them
to walk 400 meters. At the end of the study, participants in the
intervention group demonstrated significant improvement over
controls. This successful pilot study was completed in 2005 and
showed both feasibility and positive preliminary data to permit
the design and consideration of a large-scale clinical trial.
Inflammation in the Elderly: Inflammatory processes,
particularly those mediating chronic inflammation, have been
implicated as predictors or initiators of or contributors to
a number of chronic diseases and conditions of aging. NIH
currently supports research to determine relationships of
age-related changes in inflammation and inflammatory
mediators to physiologic and pathophysiologic aging changes,
risks and progression of age-related morbidity and disability,
and changes in tissue and organ function. Funded projects
include studies of vascular inflammation and neurotoxicity in
the aging brain and inflammatory responses to sleep loss.
Neuroeconomics of Aging: Scientists in the emerging field
of neuroeconomics seek to explain the psychological mechanisms
that guide economic decisions and the neurobiological pathways
that underlie them. NIH is currently supporting research to
examine the social, emotional, cognitive, and motivational
processes and neurobiological pathways of economic behavior
as they (1) influence social, financial, and health-related
decisions affecting the well-being of middle-aged and older
adults and (2) inform the development and refinement of
integrative economic theories of utility, learning, and
strategic choice relevant to aging.
National Long-Term Care Survey (NLTCS): NLTCS is an
ongoing longitudinal study supported by NIA to examine changes
in the health and functional status of older Americans and
track health expenditures. The study is one of the Nation's
preeminent resources for understanding and analyzing national
disability trends and other demographic trends to inform public
health policy. Efforts are currently under way to make the d
ata publicly available.
Improving Communication About End-of-Life Care in the ICU Reduces Symptoms of Stress, Anxiety, and Depression in Family Members:
A clinical trial supported in part by NIH found that an
intervention to improve communication between intensive care
unit clinicians and family members of a dying patient
significantly reduced feelings of stress, anxiety, and depression
in the family members. In the randomized controlled trial,
researchers examined communication guidelines that follow the
mnemonic VALUE: to Value what the family members said,
Acknowledge their emotions, Listen, Understand the patient as a
person, and Elicit family member questions. From interviews
conducted 3 months after the death of the patient, family
members in the VALUE group were found to have lower scores
for stress, anxiety, and depression than those in the
customary-practice group. The finding indicated that
improving communication in end-of-life family conferences
in the intensive care unit helped family members express
their views and emotions, accept a more realistic goal of
care, and improve their long-term psychological outcomes.
Improving End-of-Life Care: Special Supplement to the Journal of Palliative Medicine:
FY 2005, NIH sponsored the State-of-the-Science Conference on
Improving End-of-Life Care. This conference addressed the current
state of end-of-life care and proposed important new directions
for end-of-life research. Key conclusions to emerge from the
conference included: the rapid increase in older adults facing
the need for end-of-life care requires the development of
research infrastructure to better examine end-of-life issues;
enhanced communication between patients, families, and providers
is crucial to end-of-life care; and improved outcome measures are
needed to better conduct end-of-life research. In FY 2006, a
special issue of the Journal of Palliative Medicine presented
a series of papers developed from this workshop on a wide variety
of topics. The supplement includes articles on measuring
end-of-life care outcomes; analyzing racial, cultural, and
ethnic factors that influence end-of-life care; improving care
for dying children and their families; and examining factors in
the health care system that influence end-of-life care.
Centers in Self-Management or End-of-Life Research:
Future progress in improving the ability of those with chronic
disease at all stages of life to manage their own illness, as
well as improving the care of patients at the end of life, will
require the development of enhanced research capacity, in terms
of both people and institutions. In early 2007, NIH solicited
applications for the Centers in Self-Management or End-of-Life
Research. These Centers are expected to enhance research and
training capacity for interdisciplinary, biobehavioral efforts
in end-of-life and self-management science.
Rehabilitation Research
Neural Prosthesis Program: Neural prosthetic devices
restore or supplement nervous system functions that have been
lost through disease or injury, allowing people with disabilities
to lead fuller and more productive lives. The NINDS Neural
Prosthesis program pioneered the development of this technology
beginning more than 35 years ago. The program has, directly or
indirectly, catalyzed the development of cochlear implants for
the hearing impaired, respiratory and hand grasp devices for
people with spinal cord injuries, and deep brain stimulation for
patients with Parkinson's disease, among other contributions.
Current work aims to restore standing and voluntary bowel and
bladder control after spinal cord injury, to allow paralyzed
persons to control devices directly from their brains, and to
control seizures. Ongoing research also seeks to improve cochlear
implants and to advance deep brain stimulation, which may be
applicable to many brain disorders. Through the years, the
program has fostered the development of a robust research
community, now including private-sector companies, and represents
a cooperative effort among several NIH Institutes, which
coordinate their efforts with programs now under way in the
Department of Veterans Affairs and DoD.
Upper Limb Rehabilitation:
To improve the process of restoring function in the upper limbs,
NIH is developing robotic exoskeletons for rehabilitation of
upper-extremity paralysis. Recent studies demonstrate that
practicing tasks repetitively with feedback can enhance
recovery of arm function for selected populations of stroke
survivors. This type of practice typically requires the
assistance of a trained physical therapist. However, the
development of low-cost robotic exoskeletons holds the
promise of providing therapeutic activities at home
and in a variety of settings to help a wider range of
stroke patients improve functioning more efficiently.
- (E) (NICHD, NIBIB) (GPRA Goal)
High-Tech Replacements for Damaged Limbs: NIH is
investing strategically to develop improved prosthetic
devices that can help soldiers and other individuals who
have lost limbs resume normal activities. The latest
developments and research activities include a new,
“intelligent” artificial knee joint that enables a user's
lower-leg prosthesis to adjust automatically to hills,
stairs, and other variable surfaces, offering greater mobility.
Scientists are also working on developing a prototype “bionic
arm,” controlled by microprocessors that read signals through
nerves that have been rerouted from the neck to the chest.
Investigators are also seeking ways to implant an artificial
limb directly into the bone of the residual limb, doing away
with the need for a socket device, which often causes painful,
chronic irritation.
New Medical Adhesive Boasts Unique Wet-Dry Abilities: One
day, tissue engineering will make it possible to regenerate lost
facial components. Until then, victims of massive craniofacial
trauma or extensive surgeries due to cancer often must depend on
maxillofacial prosthetics to provide the form and function needed
to resume their day-to-day lives. Current adhesives are not always
retentive over long periods or changing conditions. The loss of
retention can result in visible margins or even dislodgement of
the prosthesis. Now NIH-supported scientists report they have
merged two of nature's most elegant strategies for wet and dry
adhesion. As reported in Nature, the scientists designed a
synthetic material that starts with the dry adhesive properties
of the gecko lizard and supplements it with the underwater
adhesive properties of a mussel. The hybrid material, which they
call a geckel nanoadhesive, proved in initial testing to be
adherent under dry and wet conditions and also adhered much
longer under both extremes than previous gecko-based synthetic
adhesives, a major issue in this area of research. According to
the authors, their findings mark the first time that two polar
opposite adhesion strategies in nature have been merged into a
manmade reversible adhesive. It is envisioned that the new
adhesive will be used for many medical applications,
including enhancing the retention of oral and
maxillofacial prosthetics.
Engineering Stem Cells to Repair or Replace Damaged Tissues:
Guiding a person's own stem cells to repair or replace damaged
tissues with healthy tissue is the goal of multiple NIH-supported
tissue engineering projects. For example, one team previously
reported success creating three-dimensional mandibular (jaw)
joints using rodent tissue; their continuing work on the project
addresses pragmatic questions that must be answered in order to
create functional human joints. Other teams are working on
regeneration of the temporomandibular disk, which acts as a
cushion between the bony components of the jaw joint and on
the tissue engineering of skeletal muscle. Tissue engineering
holds great promise for regeneration or replacement of dental,
oral, and craniofacial structures lost due to trauma, disease,
or congenital anomalies. The progress seen in this area will
also inform tissue engineering solutions for degeneration in
other articular surfaces, such as knee, hip, and shoulder joints.
Maintaining Physical Function in Older Populations:
Chronic disability among older Americans has dropped
dramatically, and the rate of decline has accelerated during
the past two decades, according to recent analysis of data from
the NIH National Long-Term Care Survey (NLTCS), which examined
disability changes within three age groups (65-74, 75-84, and 85+)
and found that the prevalence of chronic disability among people
age 65 and older fell from 26.5 percent in 1982 to 19 percent in
2004/2005. The proportion of people without disabilities
increased the most in the oldest age group, rising by 32.6
percent among those age 85 and older. The findings suggest that
older Americans' health and function continue to improve at a
critical time in the aging of the population. The question of how
best to maintain and accelerate the trend of declining disability,
especially in the face of increasing rates of obesity, will be
addressed at a workshop sponsored by the National Academies and
commissioned by NIH. NIH currently supports large, multidisciplinary
research programs that focus, in part, on rehabilitation research for
older people. For example, one of the Claude D. Pepper Older Americans
Independence Centers conducts exercise and motor learning-based
rehabilitation research to optimize the recovery of older adults
who have suffered a stroke, hip fracture, or other chronic debilitating
disease and translate these findings into effective community-based
rehabilitation programs (see Chapter 4). The Edward R. Roybal Centers
for Applied Gerontology conduct applied research to keep older persons
independent, active, and productive in later life.
International Collaborative Trauma and Injury Research Training Program:
Each year, more than 5 million deaths and countless disabilities result
from injuries. This program is strengthening the scientific expertise in
developing countries in human injury-related research and funds 11
collaborations between institutions in high-income countries and low- or
middle-income countries. These collaborations support research training
in applied science, the epidemiology of risk factors, acute care and survival,
rehabilitation, and long-term mental health consequences of trauma and injury.
The program is also supported by the World Health Organization, the Pan American
Health Organization, and CDC.
Cochlear Implants: One of the more groundbreaking
biomedical achievements in the last 30 years has been the
cochlear implant, an electronic device that provides a sense
of sound to individuals who are profoundly deaf or severely
hard-of-hearing. Cochlear implants process sounds from the
environment and directly stimulate the auditory nerve,
bypassing damaged portions of the inner ear. Nearly 100,000
individuals worldwide have been fitted with cochlear implants.
In the United States, approximately 22,000 adults and nearly
15,000 children have received them. Derived in part from
NIH-funded research that dates back to the early 1970s and
continues today, this remarkable technology has enabled deaf
and severely hard-of-hearing individuals to enjoy an enhanced
quality of life. NIH-supported scientists showed that
profoundly deaf children who receive cochlear implants at an
early age develop language skills at a rate comparable to that
of children with normal hearing. They also found that the
benefits of the cochlear implant in children far outweigh
its costs. Scientists can now study the large groups of
children who were identified early for hearing loss and use
this knowledge to document how treatments such as cochlear
implants can lead to improved speech and language acquisition,
academic performance, and economic outcomes for these children.
NIH Strategic Plans Pertaining to Life Stages, Human Development, and Rehabilitation Research
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
- From Cells to Selves Strategic Plan for the NICHD, 2000
- Reproductive Health for the 21st Century, 2001
- Developmental Biology, 2001
- Genetics and Fetal Antecedents of Disease Susceptibility, 2001
- Biobehavioral Development, 2001
- Targeting Sudden Infant Death Syndrome (SIDS): A Strategic Plan, 1995, 1998, 2001
- Demographic and Behavioral Sciences Branch Goals and Opportunities, 2002-2006
- Pregnancy and Perinatology Branch Strategic Plan, 2005-2010, 2003
Branch Reports to Council with Future Scientific Directions:
- Mental Retardation and Developmental Disabilities (MRDD) Branch, Report to the NACHHD Council, June 2005
- National Center for Medical Rehabilitation Research (NCMRR) Report to the NACHHD Council, January 2006
- Developmental Biology, Genetics and Teratology Branch Report to the NACHHD Council, September 2006
- Pediatric, Adolescent, and Maternal AIDS Branch (PAMAB), NICHD, Report to the NACHHD Council, June 2007
- Reproductive Sciences Branch, NICHD Report to the NACHHD Council, January 2007
- Demographic and Behavioral Sciences, NICHD Report to the NACHHD Council, September 2007
National Cancer Institute (NCI)
National Institute of Dental and Craniofacial Research (NIDCR)
National Institute on Aging (NIA)
National Institute on Drug Abuse (NIDA)
National Institute on Deafness and Other Communication Disorders (NIDCD)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Recommendations of the NIAAA Extramural Advisory Board (EAB)
National Institute of Nursing Research (NINR)
Office of Dietary Supplements (ODS)
Trans-NIH Strategic Plans
- NIH Research Plan on Down Syndrome
(NICHD, NCI, NHLBI, NIA, NIAID, NIDA, NIDCD, NIDCR, NIMH, NINDS)
- NIDDK Advances and Emerging Opportunities in Type 1 Diabetes Research: A Strategic Plan
(CC, CSR, NCCAM, NCI, NCMHD, NCRR, NEI, NHGRI,NHLBI, NIA, NIAAA, NIAID, NIBIB, NICHD, NIDA, NIDCD, NIDCR, NIDDK, NIEHS, NIGMS, NIMH, NINDS, NINR, NLM)
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88Potischman N, et al. The life course approach to cancer epidemiology. In: A Life Course Approach to Chronic Disease Epidemiology. Second Edition. Kuh D, Ben-Shlomo Y (eds). Oxford University Press, New York, 2004, p. 260-80.
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90Dabelea D, Pettitt DJ. J Pediatr Endocrinol Metab 2001;14:1085-91, PMID: 11592564
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