膳食与基因组:营养学研究的新前沿

近年来 ,基因组学的研究获得了很大进展。其中一个重要标志就是于 2 0 0 0年 6月宣告完成的人类基因组测序工作。与此同时 ,一系列应用于大规模基因测序、基因表达检测、以及基因多态性分析等的基因组新技术不断涌现。这些引人瞩目的成就正引发着包括营养学在内的几乎所有生物学科的革命性改革。大量研究 ,特别是孪生研究 (twin study)及家族研究 (family study) ,早已证实遗传因素、环境因素、以及生活方式等共同影响着常见疾病如心血管疾病、糖尿病、肿瘤、骨质疏松、老年性痴呆及肥胖等发生的遗传基因可以直接影响机体对某种疾病的易患性…     

Ethics of Informed Consent for Pragmatic Trials with New Interventions

Objectives: Pragmatic trials evaluate the comparative benefits, risks, and burdens of health care interventions in real-world conditions. Such studies are now recognized as valuable to the perimarketing stage of drug development and evaluation, with early pragmatic trials (EPTs) being explored as a means to generate real-world evidence at the time of regulatory market approval. In this article, we present an analysis of the ethical issues involved in informed consent for EPTs, in light of the generally recognized concern that traditional ethical rules governing randomized clinical trials, such as lengthy informed consent procedures, could threaten the “real world” nature of such trials. Specifically, we examine to what extent modifications (waivers or alterations) to regulatory consent for EPTs would be ethical. Methods: We first identify broadly accepted necessary conditions for modifications of informed consent (namely, the research involves no more than minimal risk of harm, the research is impracticable with regulatory consent, and the alternative to regulatory consent does not violate legitimate patient expectations) and then apply those criteria to the premarket and early postmarket contexts. Results and Conclusions: The analysis shows that neither waivers nor alterations of regulatory consent for premarket EPTs will be ethically permissible. For postmarket EPTs with newly approved interventions, waivers of consent will be ethically problematic, but some studies might be conducted in an ethical manner with alterations to regulatory consent.     

The Prevention of Global Chronic Disease: Academic Public Health's New Frontier

A confluence of stimuli is propelling academic public health to embrace the prevention of chronic disease in developing countries as its new frontier. These stimuli are a growing recognition of the epidemic, academia's call to reestablish public health as a mover of societal tectonics rather than a handmaiden to medicine's focus on the individual, and the turmoil in the US health system that makes change permissible. To enable graduating professionals to participate in the assault on chronic diseases, schools of public health must allocate budgets and other resources to this effort. The barriers to chronic disease prevention and risk factor modulation are cultural and political; confronting them will require public health to work with a wide variety of disciplines. Chronic disease will likely become the dominant global public health issue soon. In addressing this issue, academia needs to lead, not follow.     

Acceptance and Commitment: Implications for Prevention Science

Recent research in behavior analysis and clinical psychology points to the importance of language processes having to do with the control of negative cognition and emotion and the commitment to valued action. Efforts to control unwanted thoughts and feelings, also referred to as experiential avoidance (EA), appear to be associated with a diverse array of psychological and behavioral difficulties. Recent research shows that interventions that reduce EA and help people to identify and commit to the pursuit of valued directions are beneficial for ameliorating diverse problems in living. These developments have the potential to improve the efficacy of many preventive interventions. This paper reviews the basic findings in these areas and points to some ways in which these developments could enhance the impact of preventive interventions.     

Future Directions for Violence Against Women and Reproductive Health: Science,Prevention, and Action

Despite the recognition that violence may be associated with serious consequences for women's reproductive health, the understanding of the relationship between the two remains limited, as does our understanding of the most effective role for reproductive health care providers and services. This paper briefly summarizes the history of the nexus of public health, health care, and violence against women in the United States. In addition, we present some considerations for future directions for research, health care practice, and policy that will advance the understanding of the complex relationship between violence and reproductive health.     

国境口岸输入性蚊类防控措施的探讨

〔目的〕探讨我国国境口岸防控输入性蚊类的措施,为口岸卫生检疫工作提供技术支持。〔方法〕收集我国国境口岸输入性蚊类监测结果与携带病原体检测研究情况以及防控输入性蚊类的法律政策规定情况并进行总结分析。〔结果〕结合口岸卫生检疫工作需要,提出了我国口岸今后有效防止输入性蚊类及蚊媒传染病自境外传入应采取的主要控制措施。〔结论〕为保障口岸卫生安全,今后应切实加强我国国境口岸输入性蚊类的防控工作力度。     

Moving Toward a Precision-Based,Personalized Framework for Prevention Science: Introduction to the Special Issue

Prevention Science - The goal of this Special Issue is to introduce prevention scientists to an emerging form of healthcare, called precision medicine. This approach integrates investigation of the...     

Multiculturalism and Primary Prevention: Toward a New Primary Prevention Culture

The goals of this Special Issue are to highlight the following three themes: culturally affirmative conceptualizations of issues related to prevention; the selection of ecologically valid variables from the perspective of the target population; and a transactional perspective that acknowledges personal and contextual influences, including those of the researcher. Examples from contributors highlight ways in which the evolving culture of primary prevention incorporates multiculturalism. Other issues covered include the role of diverse worldviews in bounding research and programmatic objectives, the need to preserve cultural integrity in cross-cultural collaboration, practicalities of multicultural research, and ethical implications.     

Written Informed Consent for Participation in a Study and Reduction in Consent Rate

Background

The association between the method of obtaining informed consent and the consent rate in a cohort study, as well as the differences between consenters and non-consenters with regard to blood-sample donation are unclear.

Methods

We measured the consent rates among 64-year-old residents who underwent medical checkups in a city for a cohort study consisting of a questionnaire survey and blood-sample donation and determined the influence of different approaches to informed consent and the participants’ characteristics on the consent rates.

Results

Of 3,098 residents who underwent medical checkups over 10 years, 99.2% responded to the questionnaire survey, and 92.5% agreed to blood-sample donation. The consent rate for blood-sample donation after obtaining individual written informed consent was lower than that observed with the general-announcement approach. Differences in the consent rates for participation in the questionnaire study were, however, negligible. A higher percentage of men than women consented to donate blood samples. After adjustments for gender, it was observed that individuals with a history of hypertension and those without depression consented to blood-sample donation significantly more frequently.

Conclusion

The consent rate for blood-sample donation to the study decreased when the opt-in approach with written consent was used. This decrease may introduce consent bias, and the method of obtaining informed consent should be revised.Key words: Informed Consent, Consent Rate, Medical Check-up     

Early Adverse Care, Stress Neurobiology, and Prevention Science: Lessons Learned

There is growing evidence that some of the difficulties observed among children who have experienced early adverse care (e.g., children internationally adopted from institutional care and maltreated children in foster care) involve experience-induced alterations in stress-responsive neurobiological systems, including the hypothalamic–pituitary–adrenocortical (HPA) system. Thus, incorporating stress neurobiology into prevention research could aid in identifying the children most in need of preventive intervention services, elucidating the mechanisms of change in effective interventions, and providing insight into the differential responses of children to effective interventions. However, integrating stress neurobiology and prevention research is challenging. In this paper, the results of studies examining HPA system activity in children who have experienced early adverse care are reviewed, the implications of these results for prevention research are discussed, and critical steps for successfully incorporating stress neurobiology into prevention research are identified.     

Selection by Consequences: One Unifying Principle for a Transdisciplinary Science of Prevention

The principle of selection by consequences is critical to the analysis of a broad range of phenomena in the biological and behavioral sciences from the evolution of species to the selection of cultural practices. This paper reviews the role of that principle in diverse areas of the biobehavioral sciences and discusses how it can provide one dimension along which the diverse disciplines relevant to the prevention of problems of human behavior can be integrated. Such integration should improve the ability of prevention science to reduce the incidence and prevalence of human behavior problems.     

Advancing Prevention Science and Practice: Challenges,Critical Issues,and Future Directions

Progress in identifying effective programs and policies for preventing tobacco, alcohol, and illicit drug use has stimulated a growing sense of optimism about the potential of prevention science and practice. This paper summarizes some of the key challenges and critical issues that still need to be addressed for the advances of the past two decades of prevention research to have an impact on the nature of prevention practice and eventually translate into reductions in mortality and morbidity. In addition to identifying effective strategies for disseminating the use of evidence-based prevention programs and policies, issues related to implementation fidelity and adaptation need to be better understood as well as factors associated with institutionalization of effective prevention programs. Further advances in prevention science and practice will require a new emphasis on blended research models that involve conducting prevention research in practice settings with the active collaboration of researchers and practitioners.