慢性阻塞性肺疾病危险因素的研究进展

慢性阻塞性肺疾病(COPD)是21世纪困扰人类的重大慢性非传染性疾病之一,其患病率及病死率均居高不下,成为全球性问题。我国COPD高发,针对COPD开展有效防控已成为当下我国公共卫生研究重点。COPD病因复杂,危险因素众多且发病机制复杂。针对国内外相关最新研究成果,就COPD危险因素进行综述,为COPD防控提供依据。     

东北区域自然人群队列设计与实践

2016年我国在国家重点研发计划"精准医学研究"重点专项中发布国家百万自然人群队列建设项目, 建设七大区域自然人群队列。东北地区作为我国区域划分七大地区之一, 气候特征显著、膳食习惯独特且人口老龄化严重, 其慢性非传染性疾病负担居全国前列。因此, 建立东北区域大型自然人群队列, 系统探寻疾病发生和预后相关区域特色暴露因素, 为建立东北地区疾病预防新策略、降低国家医疗负担、提升东北地区人口健康水平, 具有重要意义。2018年7月, 东北区域自然人群队列现场工作启动, 现场工作内容主要包括对参与者进行问卷调查、体格检查, 以及血、尿、粪便样本的采集和检测, 截至目前, 队列总计完成各年龄层共115 414人的基线数据收集工作。本文简要介绍了东北区域自然人群队列建设概况, 为国内相关研究提供参考。     

西南区域自然人群队列简介与研究进展

近年来我国慢性非传染性疾病(慢性病)负担逐年加重, 且存在区域异质性。我国西南地区地域辽阔, 民族众多, 地域特色鲜明, 慢性病负担沉重, 但卫生资源相对匮乏, 高危慢性病防控形势严峻。为全面深入解析我国西南地区多民族人群疾病分布模式和潜在暴露风险规律, 西南区域自然人群队列项目组受国家重点研发计划"精准医学研究"重点专项资助, 于2017年启动西南区域自然人群队列建设。目前, 西南区域自然人群队列在四川省、云南省、贵州省、西藏自治区、重庆市5省/市/自治区共招募119 556名30～79岁居民(西藏自治区为18～79岁), 已建成大规模、多民族、高质量自然人群队列及生物样本库。项目组围绕西南自然环境、生活方式的健康效应已取得初步研究进展, 并对欠发达地区大型队列的构建模式进行了创新, 可为复杂地理场景的大规模自然人群队列建立与研究提供借鉴, 为我国精准医学研究与多民族疾病防控决策提供高质量基础资源。     

我国慢性非传染性疾病社区综合防治模式

慢性非传染性疾病已成为危害我国人民健康的重大公共卫生问题。预防和控制策略是以社区为基础，以健康教育和健康促进为主要手段，针对共同危险因素，在全人群和目标人群中开展慢性非传染性疾病综合防治。     

慢性非传染性疾病社区综合防治(二)

慢性非传染性疾病危险因素的干预1 慢性非传染性疾病危险因素的定义和特点　目前,病因学的发展已使人们接受了以下观点,即那些能使人群发病率升高的因素,就可以认为是病因,其中某个或多个因素不存在时,人群疾病频率就会下降。病因在流行病学中一般被称为疾病的危险因素,其含义就是使疾病发生概率即危险性升高的因素。慢性非传染性疾病不同于一般的传染性疾病,它受多种因素长期影响所致,多病因、多基因、多阶段、潜伏期长,其致病因素已不再是单纯的生物病原,还包括许多社会环境因素、个人行为、生活方式等。传统的生物医学模式不能很好地解释…     

亚欧地区部分国家队列研究进展分析

目的 梳理西亚地区17个国家和中东欧地区16个国家队列研究概况,分析典型前瞻性自然人群队列的分布、建设及发展状况。方法 采用文献回顾法收集队列研究的基本信息,采用描述性研究方法分析队列研究的特征。结果 西亚和中东欧地区各国共有样本量在1 000人及以上的队列研究562项,国家内队列研究468项（83.27%）,国际多中心队列研究94项（16.73%）;从研究性质来看,病因学研究347项（61.74%）;从研究内容来看,慢性非传染性疾病研究310项（55.16%）,母婴健康研究125项（22.24%）,其中,慢性非传染性疾病研究中,癌症研究51项（16.45%）,心血管疾病研究83项（26.77%）;共有大型前瞻性自然人群队列研究10项,主要分布在伊朗和欧洲地区各国,均为在研项目,持续时间在8～29年之间,队列规模>50 000人的4项;从建立机制看,均进行流行病学调查、健康体检和生物样本收集;从队列发展来看,10项队列研究中有9项在建设初期发表文章较少,随后逐年增长并保持在一定水平上下波动。结论 西亚和中东欧地区各国队列研究地区分布不平衡,主要进行病因学研究,重点关注癌症、心血管疾病、糖尿病、呼吸系统疾病、精神心理疾病等慢性非传染性疾病和母婴健康,具有少数可供借鉴的大型前瞻性自然人群队列。     

成年期慢性非传染性疾病早期起源的研究进展基于赫尔辛基出生队列研究

赫尔辛基出生队列研究历经数十年的长期随访,获得了一系列生命早期生长发育与成年期慢性非传染性疾病相关的研究成果,为揭示成年期慢性非传染性疾病发生发展的起因和早期预防提供了科学依据。现对该出生队列关于成年期慢性非传染性疾病早期起源的主要研究成果进行综述,为我国开展大型出生队列研究提供一定的经验借鉴。     

城乡居民营养知识健康教育干预效果评价

随着中国经济的发展,城乡居民膳食状况的明显改善,膳食结构和生活方式发生了重大变化,与之相关的慢性非传染性疾病如肥胖、高血压、糖尿病、血脂异常等患病率增加,已成为威胁国民健康的突出问题。因此,开展营养知识宣传教育,引导居民合理膳食很有必要[1]。为积极探索城乡居民实施营     

综合干预对饮食习惯改变及肥胖病人自我管理的效果评价

慢性非传染性疾病与人群的不良生活方式密切相关,不良的生活方式包括膳食不合理、缺乏运动、吸烟、酗酒等[1]。2002年12月北京市政府启动了《生活方式疾病综合防治示范社区项目》(简称《示范项目》),《示范项目》是针对慢性病病程长、病因复杂、尚无明确病因,同时在社区卫生诊断基础上所采取的不同层面上的综合干预项目。有证据表明不健康膳食和缺乏体力活动是慢性病尤其是肥胖的重要危险因素[2],因此,开展健康的膳食干预也是本项目的重要内容。北京市朝阳区朝外、高碑店2个办事处作为示范单位参加了此项目。经过2年的项目干预,社区居民的健…     

华南区域自然人群慢性非传染性疾病前瞻性队列研究建设概况

随着生活行为方式、自然和社会环境的急剧变化, 我国慢性非传染性疾病(慢性病)的流行现状及相关危险因素也发生了巨大的改变。全国各地各类慢性病的流行特征及其危险因素分布不尽相同, 而华南地区独特的气候、饮食及生活方式对慢性病发生发展的影响至今尚不明确。因此, 亟需通过区域性大型队列的建设, 为区域重大疾病的病因学研究、早期预测和干预策略提供本土化人群证据, 也为国家重大慢性病防治策略的制定提供依据。华南区域自然人群慢性病前瞻性队列于2017年12月正式启动, 覆盖广东省、广西壮族自治区、福建省和海南省, 以35～74岁常住居民为主要研究对象, 包括城市与农村、汉族与以壮族为代表的少数民族多类型自然人群。本队列围绕华南区域常见重大慢性病建立集健康信息和生物样本为一体的精准医学大数据平台, 并开展长期随访。现已建立116 520人的基线数据库, 年龄为(54.9±12.5)岁, 女性71 077人(61.0%)。基线数据库包括问卷调查、体格检查数据以及生物样本。本文对华南区域自然人群慢性病前瞻性队列设计的理念、研究进展和随访设想作简要介绍。     

大型人群队列研究随访监测设计研究进展

随着人们对复杂性疾病病因研究需求的日益提升,大型队列研究逐渐替代传统小样本队列研究,成为流行病学研究的热点。随访作为队列研究中的获取疾病发病、死亡以及迁移或失访资料的重要环节,其质量对队列研究的结论有着直接影响。因此,制定合理的随访监测方案成为大型队列研究成功的关键。本文主要针对目前国内外大型队列研究随访监测的内容和方...     

The politics of non-communicable diseases in the global South

In this paper, we explore the emergence of non-communicable diseases (NCDs) as an object of political concern in and for countries of the global South. While epidemiologists and public health practitioners and scholars have long expressed concern with the changing global distribution of the burden of NCDs, it is only in more recent years that the aetiology, politics and consequences of these shifts have become an object of critical social scientific enquiry. These shifts mark the starting point for this special issue on ‘The Politics of NCDs in the Global South’ and act as the basis for new, critical interventions in how we understand NCDs. In this paper, we aim not only to introduce and contextualise the six contributions that form this special issue, but also to identify and explore three themes – problematisation, care and culture – that index the main areas of analytical and empirical concern that have motivated analyses of NCDs in the global South and are central to critical engagement with their political contours.     

大型人群队列研究数据管理团体标准解读

精准医学已成为我国科学技术优先发展的重点战略，大型人群队列的建设是人群疾病防治的重要资源，其研究结果为个体化治疗和精准预防提供科学证据。因此，如何规范化的建设大型人群队列是上述工作的基础。中华预防医学会组织北京大学等单位撰写《大型人群队列研究数据处理技术规范（T/CPMA 001-2018）》和《大型人群队列研究数据安全技术规范（T/CPMA 002-2018）》两项团体标准。标准以"科学性、规范性、可行性、可推广性"为原则，提出了大型人群队列研究在数据标准化技术、数据清理及质控技术、数据整合技术、数据隐私保护技术和数据库安全稳定性管理技术的原则和具体要求，以指导和规范我国已建立或拟开展的大型人群队列、区域性人群队列以及特殊人群队列，促进国内科研水平的提升，增加国际影响力，最大程度的支持疾病防控的决策与实践。     

Gaps and opportunities for nutrition research in relation to non-communicable diseases in Arab countries: Call for an informed research agenda

Effective public health nutrition interventions are needed to curb the escalating prevalence of non-communicable diseases (NCDs) in many Arab countries. In order to generate the scientific evidence needed for the success of these interventions, an informed research agenda should be developed. The purpose of this review is to identify gaps and opportunities for research on nutrition and NCDs among Arab countries, which is an important step towards the formulation of this research agenda. Published papers that addressed nutrition and NCDs in Arab countries between the years 2006 and 2015 were reviewed (n = 824). The main gaps identified were related to the predominance of laboratory-based studies with few cohort and intervention studies, and the small percentage of articles examining dietary patterns. While food frequency questionnaires were the main dietary assessment method used, only 35% were validated. Very few studies included children and the majority considered nutrition in isolation, excluding other environmental factors. Opportunities identified included the promising momentum in studying nutrition and NCDs among Arab countries, evidenced by an increasing number of articles published over the years, that may be guided in future nutrition research to fill the identified gaps. In addition, the higher number of articles in high-income countries coupled with the impact of papers in middle-income countries suggests an opportunity of synergistic collaboration among these countries. The identified gaps and opportunities in this review may serve as basis for Arab countries to start developing a research agenda in the area of nutrition and NCDs.     

Associations between Consumption of Dietary Fibers and the Risk of Type 2 Diabetes,Hypertension, Obesity,Cardiovascular Diseases,and Mortality in Chinese Adults: Longitudinal Analyses from the China Health and Nutrition Survey

Although many studies have explored the relationship between total dietary fiber intake and the risk of chronic non-communicable diseases, the results are mixed. There is also a lack of research on the association between dietary fiber intake from different food sources and disease. Using data from the China Nutrition and Health Database from 2004 to 2015, Cox proportional risk models were used to explore the associations between total dietary fiber and fiber intake from different food sources and the occurrence of type 2 diabetes, hypertension, obesity, cardiovascular disease, and all-cause mortality. After multi-factorial adjustment, the hazard ratios (95% confidence interval) of total dietary fiber intake (quartile 4 vs. quartile 1) in type 2 diabetes, hypertension, obesity, cardiovascular disease, and all-cause mortality cohorts were 1.20 (0.93, 1.55), 0.91 (0.75, 1.12), 0.93 (0.64, 1.35), 1.13 (0.60, 2.12), 1.13 (0.60, 2.12), and 1.13 (0.84, 1.52). Whole-grain fiber intake was positively associated with hypertension but not with the occurrence of other diseases. No association was observed between legume fibers, fruit fibers, and vegetable fibers in the cohorts of type 2 diabetes, hypertension, obesity, cardiovascular diseases and all-cause mortality. Our study did not find any association between total dietary fiber and dietary fiber intake from different food sources and type 2 diabetes, obesity, cardiovascular disease, and all-cause mortality in the Chinese population. The role of dietary fiber in the Chinese population may be overestimated. More extraordinary efforts are needed to further confirm the association between dietary fiber and these diseases in the Chinese population.     

Examining the Validity and Utility of Montreal Cognitive Assessment Domain Scores for Early Neurocognitive Disorders

ObjectivesMontreal Cognitive Assessment (MoCA) total scores have been widely used to identify individuals with neurocognitive disorders (NCDs), but the utility of its domain-specific scores have yet to be thoroughly interrogated. This study aimed to validate MoCA's 6 domain-specific scores (ie, Memory, Language, Attention, Executive, Visuospatial, and Orientation) with conventional neuropsychological tests and explore whether MoCA domain scores could discriminate between different etiologies in early NCDs.DesignBaseline data of a cohort study.Setting and ParticipantsStudy included 14,571 participants recruited from Alzheimer's Disease Centers across United States, aged ≥50 years, with global Clinical Dementia Rating of ≤1, and mean age of 71.8 ± 8.9 years.MethodsParticipants completed MoCA, conventional neuropsychological tests, and underwent standardized assessments to diagnose various etiologies of NCDs. Partial correlation coefficient was used to examine construct validity between Z scores of neuropsychological tests and MoCA domain scores, whereas multinomial logistic regression examined utility of domain scores to differentiate between etiologies of early NCDs.ResultsMoCA domain scores correlated stronger with equivalent constructs (r = 0.15-0.43, P < .001), and showed divergence from dissimilar constructs on neuropsychological tests. Participants with Alzheimer's disease were associated with greater impairment in Memory, Attention, Visuospatial, and Orientation domains (RRR = 1.13-1.55, P < .001). Participants with Lewy body disease were impaired in Attention and Visuospatial domains (RRR = 1.21-1.47, P < .001); participants with frontotemporal lobar degeneration were impaired in Language, Executive, and Orientation domains (RRR = 1.25-1.75, P < .01); and participants with Vascular disease were impaired in Attention domain (RRR = 1.14, P < .001).Conclusions and ImplicationsMoCA domain scores approximate well-established neuropsychological tests and can be valuable in discriminating different etiologies of early NCDs. Although MoCA domain scores may not fully substitute neuropsychological tests, especially in the context of diagnostic uncertainties, they can complement MoCA total scores as part of systematic evaluation of early NCDs and conserve the use of neuropsychological tests to patients who are more likely to require further assessments.     

Global and Regional Patterns in Noncommunicable Diseases and Dietary Factors across National Income Levels

Background: Noncommunicable diseases (NCDs) are the leading global cause of death and share common risk factors. Little quantitative data are available on the patterns of each NCDs death and dietary factors by national income level and region. We aimed to identify the trend of NCDs deaths and dietary factors with other health-related behaviors across national income levels and geographical regions. Methods: Three databases were collected, including the World Health Organization, Food and Agriculture Organization, and World Bank in 2014. These were analyzed to describe the trend for NCDs deaths and dietary factors with health-related behaviors across national income levels (high income, upper-middle income, lower-middle income, and low income) from 151 countries using variance-weighted least-squares linear regression. Results: Lower-middle-income and low-income countries in Africa and Asia had higher death rates of NCDs. More than 30% of the population had raised blood pressure with higher carbohydrate intake and lower protein and fat intake compared to high-income European countries in 2014. High-income countries had the highest prevalence of raised total cholesterol, overweight, and obesity, the highest total energy, fat, and protein intake, and the highest supplies of animal fat, stimulants, sugar and sweetener, vegetable oil, and milk, as well as insufficient activity with an increasing trend (p for trend < 0.001). Conclusion: There were differences in NCDs risk factors and dietary factors by national income and region. Accordingly, measures should be taken to suit the situation in each country. Our findings have significance for health workers and health policies preventing and controlling the rise of NCDs.     

Internationale Kohortenstudien

Among observational studies, cohort studies, i.e. longitudinal observations of selected population groups, provide the highest possible evidence of a causal association between specific risk factors (exposure) and the occurrence of disease in populations. Besides the fact that many exposures cannot be investigated in experimental designs, cohort studies have the advantage over randomized clinical trials that they are conducted in free living populations and not in restrictive, clinical settings. In this paper we describe the aims and features of international cohorts that have been selected because of their impact, their size or their endpoints. We do not only present the study designs and survey instruments used but we also highlight some of the most important results gained by these studies. Most of these prospective studies investigated common chronic diseases in the elderly, such as cancer, diabetes, cardiovascular or neurodegenerative diseases, osteoporosis and ophthalmologic disorders. Newer cohorts and recent reassessments of existing cohorts almost always include the collection and storage of biological samples. In recent years technological developments allowed the implementation of cutting edge measurement procedures, such as imaging techniques for phenotyping. Finally, we discuss on the one hand whether these designs can be transferred to the German situation and on the other hand to what degree the results obtained from foreign cohorts can be generalized for the German population. We conclude with recommendations for future cohort studies.