双生子方法在糖尿病析因研究中的应用进展

糖尿病是一种由遗传和环境因素共同作用导致的复杂疾病,严重影响人群健康水平和生存质量,双生子方法作为特殊的研究工具,可以估计基因和环境对糖尿病相关性状的相对作用。与一般研究对象相比,双生子拥有自然对照,结合遗传统计学和分子生物学技术进行方法学的拓展,有助于解析疾病危险因素,明确暴露与结局的真实关联。本文对国内外近十年来双生子方法在糖尿病析因研究中的应用进展进行了综述,总结了经典双生子模型、对内对照研究、全基因组和表观遗传流行病学研究等方法的优势和局限性。     

界标分析在队列研究中的应用及实例分析

队列研究设计具有时序关系明确的特点，其论证因果关联的强度优于其他观察性研究，是分析性流行病学的重要研究方法之一。然而，队列研究对象的纳入过程中常采用筛检诊断或其他方式排除已出现结局事件的个体，而筛检诊断的准确性、排除的有效性会影响纳入研究个体基线状况评估的准确性，进而导致对因果效应的估计可能存在暴露-结局因果倒置。界标分析可以通过排除可能存在暴露-结局时序不明的研究对象以控制反向因果。本研究阐述界标分析的基本原理与分析步骤，并运用中国老年人健康长寿影响因素调查的数据探索体育锻炼与虚弱的关系，展示界标分析的具体应用，以期促进其在队列研究中的应用，从而更准确地推断暴露与结局的因果效应。     

公共卫生实践中的队列研究及其意义

队列研究在阐明危险因素与疾病关联中发挥着重要的作用,广泛应用于病因研究、疾病预后评估、疾病自然史以及新药上市后监测等方面。队列研究提供的数据具有非常强的科学性,可为公共卫生实践提供所需要的依据。队列研究实施前一定要进行科学设计。队列研究设计时应当重点考虑样本量、暴露和非暴露人群的选择、随访、结局判断以及研究的时长、分析的指标和方法等。队列研究已经成为获取科学依据的重要途径。国际知名的人群研究队列如中国慢性病前瞻性研究和弗雷明汉心脏研究队列等,为促进人类的健康提供了大量的具有科学价值的证据。队列研究所提供数据的质量极为重要,队列研究要不断纳入新技术和新方法,以提供客观、准确、可靠的手段来确定暴露和结局,并控制偏倚。队列研究有着非常大的应用空间,必将为维护人类健康的策略和措施的制定提供更多高水平的科学证据。     

京津冀自然人群队列研究的理念与实践

队列研究是探索病因和疾病防治知识发现的最有效工具之一。队列研究在我国已有60余年的工作基础,尤其自2016年科技部首次对队列研究专门立项以来,我国队列研究的种类和数量急剧增加。现代队列研究需要在经典的队列研究设计原则基础上,充分应用现代多学科资源和技术方法,以使暴露与结局关联分析和病因推断更加系统和精准。本文介绍了京津冀自然人群队列研究设计的理念、研究进展和挑战,以及在实施中应对的关键问题,可为国内队列研究及其随访机制建设提供参考。     

海南百岁老人主要健康指标及其与生存质量的关联研究

百岁老人作为研究健康老龄化的"模板人群", 探索其健康长寿特征及其相关影响因素, 有助于探讨我国人口老龄化背景下实现健康长寿的可能路径。近年来, 包括中国海南百岁老人队列研究(CHCCS)在内的长寿人群观察性研究报道了百岁老人主要健康特征与生存质量的关联。本文旨在综述CHCCS近年来发现的相关研究证据并结合国内同类研究结果进行分析。其中主要健康指标包括血压、血脂、血糖、血红蛋白、身体测量指标和肾功能等;生存质量及健康结局包括饮食、营养、健康相关生活质量、日常活动能力、老年综合征等。以期为制定健康老龄化政策提供相关人群流行病学证据。     

能量控制模型在营养流行病学研究中的应用

在营养流行病学研究中使用能量控制模型能够从膳食组分摄入量中排除总能量摄入的混杂作用,探究膳食组分摄入与研究结局之间的真实关联。本文介绍了标准多元模型、营养素残差模型、能量分解模型和多元营养素密度模型四种能量控制模型。并以美国国家健康和营养调查研究数据为例,分别采用各种能量控制模型分析饱和脂肪酸摄入量与全因死亡率之间的关联,比较不同能量控制模型的分析结果。分析显示各种能量控制模型结果基本一致,均能较好地控制能量摄入水平的影响。     

代谢综合征对中国中老年人日常生活活动能力影响的前瞻性队列研究

目的:探讨我国中老年人代谢综合征（MS）与日常生活活动能力（ADL）受损的关联,为提高人口健康预期寿命提供依据。方法:采用前瞻性队列研究设计,利用2011-2018年中国健康与养老追踪调查数据,以2011年数据为基线,分别在2013、2015和2018年随访ADL结局,且以2013年和2015年新进入队列的人群作为基线...     

身体测量指标与胃癌发病风险的流行病学研究进展

胃癌是严重威胁人类健康的最重要恶性肿瘤之一。流行病学研究提示,身体测量指标与胃癌发病可能存在关联,目前研究结果尚不一致。本文通过查阅PubMed、万方数据知识服务平台等数据库文献,系统回顾了国内外关于身体测量指标与消化系统恶性肿瘤发病关系的前瞻性队列研究,并进行总结,结果显示,全身性肥胖和腹型肥胖可能与贲门癌发病风险相关,体重过轻与胃癌发病关联需进一步确证。本文从身体测量指标角度出发综述了胃癌发病的研究进展,以期为该领域未来研究方向提供思路,并为人群的胃癌防治提供科学依据。     

云端信息平台在中国国家出生队列建设与研究中的应用

大型出生队列是持续、动态地收集个体生命早期暴露信息,探讨暴露与生命远期健康结局因果关联的一种重要的队列研究类型。但由于其设计复杂、实施难度大,如何保证出生队列建设的高质量高效率是国内外流行病学研究者面临的主要挑战。2016年,国家重点研发计划资助的中国国家出生队列（China National Birth Cohort...     

社区中老年人静坐行为与第1秒用力呼气容积下降的关联研究

目的分析社区≥40岁中老年人静坐行为与第1秒用力呼气容积(FEV1)下降的关联。方法基于上海郊区自然人群队列, 对其中部分≥40岁人群开展肺功能检查和国际体力活动问卷调查, 采用广义加性模型分析研究人群及不同性别、年龄亚组的静坐行为特征及其与FEV1下降的关联。结果 3 121名≥40岁研究对象中, FEV1下降占14.8%, 男性高于女性。完全静坐行为者占24.8%, 每日静坐时间及完全静坐行为占比性别及年龄别差异均无统计学意义(P>0.05)。在<60岁女性中, 完全静坐行为组与FEV1下降的关联是非完全静坐行为组的2.04(95%CI:1.11～3.72)倍。在<60岁的男性中, FEV1下降与每日静坐时间增加呈正相关(OR=1.16, 95%CI:1.04～1.29);静坐时间>5 h/d组与FEV1下降的关联强度是≤5 h/d组的3.02(95%CI:1.28～7.16)倍。上述关联在敏感性分析中仍然存在。结论 <60岁人群FEV1下降与静坐行为相关, 在女性中与完全静坐行为, 即中高强度体力活动水平的缺失相关;而在男性中与每日静坐时间的增加有关...     

Effects of reallocating physical activity,sedentary behaviors,and sleep on mental health in adolescents

ObjectivePhysical activity, sedentary behavior, and sleep are associated with mental health in adolescents. Mental health may depend not only on the amount of time spent in a specific activity, but also on the activity it displaces. The aim of this study was to examine the impact of reallocating 15 min of time spent in one health behavior with 15 min in another on adolescent mental health.MethodsCross-sectional data from the students participating in the COMPASS Study (2018–2019) were analyzed (N = 46,413). Participants self-reported the amount of time they spent engaged in moderate-to-vigorous physical activity (MVPA), doing homework and using screens, and their sleep duration on average each day, depressive symptoms, anxiety, and flourishing. Data were analyzed using isotemporal substitution modeling.ResultsAmong adolescents getting less than the recommended amount of sleep, replacing any behavior with sleep was generally associated with better mental health outcomes. Conversely, among adolescents getting adequate sleep, the findings did not support replacing other behaviors with sleep with the exception of screen time. Replacing homework and MVPA with sleep was associated with less flourishing regardless of sleep duration.ConclusionsReplacing screen time with any behavior may be better for mental health outcomes. Results provide further support for the critical role of sleep in promoting healthy development during adolescence, though more sleep than is recommended may confer little benefit for mental health. The findings demonstrate that mental health benefits may be obtainable at intervals as short as 15 min.     

健康行为改变的多理论模型综述

健康行为对疾病的预防与发现、治疗与康复以及身心健康的促进与维持具有重要意义。健康行为改变的多理论模型［multi-theory model （MTM） of health behavior change,MTM］是用于预测健康行为改变的理论模型,其预测效果已在国外的研究中初步呈现。本文通过对国外现有研究进行文献综述,介绍了MTM的定义、发展、构成、方法、研究现状和应用中的优缺点,以期为今后我国在该领域的实证研究提供客观参考。     

儿童青少年身体素养对身体活动促进的意义

儿童青少年身体活动不足,与持续的体质下降及日益严重的肥胖、近视等健康问题密切相关,已成为全球性的公共卫生问题.儿童青少年身体活动促进受到体育科学和公共卫生领域的共同关注.然而,基于健康结果为导向的身体活动促进模式未能收到良好效果.本文基于身体素养概念、身体素养构成要素、直接与间接的证据阐述身体素养与儿童青少年身体活动促进的关系,并指出未来需要更多的实证研究,如开发中国不同年龄和身体状况的儿童青少年群体身体素养测评工具;开展身体素养与身体活动参与及健康关系的纵向研究;身体素养干预对身体活动行为及健康结局的直接影响.身体素养提升成为促进儿童青少年身体活动参与及体质健康的重要途径,降低因身体活动不足带来的公共卫生负担.     

The association of physical activity,sleep, and screen time with mental health in Canadian adolescents during the COVID-19 pandemic: A longitudinal isotemporal substitution analysis

BackgroundThe impact of COVID-19 on adolescent mental health is a global concern. Increased screen time and reduced physical activity due to the lockdown measures have been linked to detrimental mental health outcomes; however, the literature remains limited by cross-sectional and retrospective designs, and consideration of behaviours in isolation. Prospective evidence is necessary to examine whether moderate-to-vigorous physical activity (MVPA), sleep and screen time influenced changes in mental health.MethodAnalyses used data from a prospective cohort study of secondary school students in Canada with baseline data from the 2018–2019 school year and linked follow-up data from online surveys completed during the initial COVID-19 outbreak (May–July 2020). Multilevel linear regression models were used to evaluate the within- and between-person isotemporal substitution effects of sleep, MVPA and screen time behaviours on depression, anxiety, subjective well-being, and trait emotional dysregulation.ResultsLinked longitudinal data from 2645 students attending 44 schools were available. Between-person effects indicated that individuals who engaged in more MVPA and sleep while minimizing screen time had lower depression scores, less severe emotional dysregulation, and better subjective well-being. While controlling for between-person effects, within-person year-on-year change suggests those who increased screen time while decreasing either MVPA or sleep experienced mental health decline on all outcomes.ConclusionMVPA and sleep were associated with youth mental health during the early COVID-19 lockdown. Increasing MVPA and sleep (or at least mitigating the increase of screen time) compared to the prior year was associated with better mental health during the early pandemic. A limitation to consider is that the screen time measure represents a combination of screen behaviours, and effects of replacing screen time may have varied if distinctions were made.     

儿童青少年24 h活动行为与肥胖关联的系统评价

目的 针对基于成分数据分析的研究，系统评价身体活动(physical activity, PA)、久坐行为(sedentary behavior, SB)和睡眠与肥胖的关联或等时替代效应，为儿童青少年肥胖干预提供参考。方法 在中国知网、万方数据库、PubMed、SPORTDiscus、Web of Science和Medline数据库检索发表于2014年1月1日至2022年5月1日的相关研究。2名有经验的评价员独立完成文献的筛选、数据提取以及质量评估。结果 共纳入文献16篇，文献质量得分范围为7～12分。中高强度身体活动(moderate to vigorous physical activity, MVPA)、睡眠与肥胖均呈负相关，且MVPA替代其他行为可降低肥胖风险，替代时间为1.5～60 min/d。低强度身体活动(light physical activity, LPA)、SB与肥胖均呈正相关(P值均<0.05)。结论MVPA是儿童青少年肥胖干预的主要着眼点，在现有身体活动水平的基础上，每周增加60 min的MVPA可能是降低肥胖风险的最小量。     

母亲抑郁对儿童综合发展的影响

母亲抑郁是指孕期或产后发作的非精神病性抑郁障碍。母亲抑郁不仅会引起孕产妇的躯体和精神症状,还会对子代发育造成影响。许多流行病学研究结果表明孕产妇抑郁影响胎儿宫内发育,还会引起儿童的内化和外化障碍等一系列健康问题,甚至与成年期的精神状态都有着密切的联系。本文从母亲抑郁与新生儿结局和儿童的认知、行为、情绪、身体健康状况等方面进行综述,以期探索母亲抑郁与儿童发展的关联,并为今后开展相关研究提供科学依据。     

How Does Online Patient–Provider Communication Heal? Examining the Role of Patient Satisfaction and Communication Experience in China

ABSTRACT

China is facing the problem of having health care that is difficult to access. Online patient–provider communication (OPPC) may bring a new option to deliver health services. However, online communication with doctors is still novel to many people in China. Little research has been conducted to examine how OPPC could improve health outcomes. With an integrated model that incorporates social cognitive theory into the three-stage model of health promotion using interactive media, this study tested the social mechanism underlying the impact of OPPC. Results indicated that self-efficacy, behavioral capability, and outcome expectation positively predicted OPPC at Stage 1, which in turn increased patient satisfaction at Stage 2, which finally improved three types of health outcomes (general, emotional, and physical) at Stage 3. In addition, quality of users’ experience in OPPC positively moderated this mediation pathway. Theoretical and practical implications of this study were also discussed.     

Physical and mental health outcomes of prenatal maternal stress in human and animal studies: a review of recent evidence

Prenatal maternal stress (PNMS) has been linked with adverse health outcomes in the offspring through experimental studies using animal models and epidemiological studies of human populations. The purpose of this review article is to establish a parallel between animal and human studies, while focusing on methodological issues and gaps in knowledge. The review examines the quality of recent evidence for prevailing PNMS theoretical models, namely the biopsychosocial model for adverse pregnancy outcomes and the fetal programming model for chronic diseases. The investigators used PubMed (2000–06) to identify recently published original articles in the English language literature. A total of 103 (60 human and 43 animal) studies were examined.
Most human studies originated from developed countries, thus limiting generalisability to developing nations. Most animal studies were conducted on non-primates, rendering extrapolation of findings to pregnant women less straightforward. PNMS definition and measurement were heterogeneous across studies examining similar research questions, thus precluding the conduct of meta-analyses. In human studies, physical health outcomes were often restricted to birth complications while mental health outcomes included postnatal developmental disorders and psychiatric conditions in children, adolescents and adults. Diverse health outcomes were considered in animal studies, some being useful models for depression, schizophrenia or attention deficit hyperactivity disorder in human populations. The overall evidence is consistent with independent effects of PNMS on perinatal and postnatal outcomes. Intervention studies and large population-based cohort studies combining repeated multi-dimensional and standardised PNMS measurements with biomarkers of stress are needed to further understand PNMS aetiology and pathophysiology in human populations.     

Improving the health and health behaviors of women aging with physical disabilities: A peer-led health promotion program

OBJECTIVE: To examine the efficacy of a health promotion program for women aging with physical disabilities. METHOD: A sample of 137 middle-aged and older women with physical disabilities was randomly assigned to either an 8-week health promotion program or to a wait-list control group. Both groups completed questionnaires before, immediately after, and 3 months after the intervention. RESULTS: Relative to women in the control group, women in the health-promotion program demonstrated improvements in health behaviors, most of which were maintained at follow-up. The intervention group showed some improvements on measures of physical health, but there was little evidence of improvement in psychological health outcomes. Testing our theoretical model, self-efficacy was supported as a mediator of the effect of the intervention on health behaviors, and health behaviors combined with self-efficacy were supported as mediators of the effect of the intervention on physical health outcomes. Contrary to our hypotheses, our measures of social support and social connectedness were not affected by the intervention. CONCLUSIONS: A brief, peer-led, group health promotion program resulted in improved scores on measures of self-efficacy, increased health behavior, and physical health. Self-efficacy, which was supported as a mediator in the effect of the intervention on behaviors and health outcomes, should remain an important focus of future interventions with this population.     

抑郁症状对社区亚老龄及老龄人群心身健康结局影响的随访研究

目的 探索抑郁症对社区老年人群健康结局的影响。方法 对上海市静安区同一批非痴呆55岁以上人群应用中文版流行病学调查用抑郁自评量表（CES-D）等调查工具，进行5年随访。按当年抑郁症状的严重程度，对5年后多项心理和躯体健康结局指标进行多因素分析。结果 （1）2次面访者2927名。按照首次CES-D得分将有无抑郁症状分为4个等级，基线分布除年龄外、性别、教育程度、中文版简易智能状态检查（MMSE）、日常生活活动能力量表（ADL）差异均存在显著性。（2）以首次CES-D分数、年龄、性别、教育程度、MMSE、ADL为自变量，进行多元回归分析发现，CES-D得分与5年后MMSE、ADL、生活满意度指数A（LSIA）得分无显著性相关。（3）在控制基线变量后，首次CES-D得分与5年自我健康评价、记忆力自我评价呈显著性正相关。（4）分别以5年后躯体疾病指数、是否死亡为因变量，以首次CES-D得分等级、年龄、性别、教育程度、MMSE、ADL为自变量，进行多元logistic回归分析。在躯体疾病影响指数和死亡的风险预测中，5年前抑郁症状影响最大，其OR值分别为1.52(95%CI:1.19-1.95)和2.68(95%CI:1.41-5.06)。结论 抑郁症状是影响社区老年人心身健康结局的主要因素之一。