新形势下公共卫生与预防医学发展的新机遇

在"健康中国2030"的国家战略下,公共卫生与预防医学学科发展面临新的形势:（1）以组学为代表的新技术不断被应用于疾病防控与健康促进的工作中;（2）计算机技术和医学信息技术正推动本学科在大数据时代的发展与变革;（3）在全国不同区域,围绕不同疾病,启动了大型人群队列建设,为本学科的发展提供了宝贵的契机。本学科应重点围绕组学技术与队列人群、大数据与疾病防控、自然和社会新态势与全民健康等方面,培养复合型研究人才与研究团队,拓展学科研究领域和覆盖面,为推进健康中国建设构建强大保障。     

我国营养膳食防治慢性病的研究进展

合理营养膳食是降低慢性病发病风险的主要措施。近年来，我国营养学科领域在利用大型人群队列研究揭示营养膳食与慢性病风险的关系，探讨营养膳食模式、营养物质暴露水平、营养素和食物活性物质对慢性病的影响等方面取得了丰硕的研究成果，部分成果位于本领域的国际前沿水平。     

推动我国公共卫生领域的团体标准建设

为深入贯彻落实国务院《深化标准化工作改革方案》，推动以标准引领预防医学和公共卫生事业健康发展，中华预防医学会成立了中华预防医学会标准化工作委员会，承担学会团体标准的立项资格审查、立项评审、标准预审、标准会审、标准宣传培训、标准实施评估、标准复审和标准舆情监测应对等标准化工作。中华预防医学会于2018年12月13日发布了《大型人群队列研究数据处理技术规范（T/CPMA 001-2018）》团体标准和《大型人群队列研究数据安全技术规范（T/CPMA 002-2018）》团体标准。上述标准是我国人群队列建设和研究领域首次发布的团体标准，亦是中华预防医学会首次发布的团体标准，是我国以李立明教授为领衔的团队历经十余年研究和实践的学术成果，具有里程碑意义。上述标准的制定以中国慢性病前瞻性研究项目为基础。旨在制定符合国情、可推广的人群队列建设的行业标准和规范化操作流程，指导其他人群队列的建设，最大程度的支持疾病防控的决策与实践。慢性病疾病负担日益增加是当前严重的公共卫生问题。慢性病的成因非常复杂，大型队列研究对于观察、阐释慢性病的病因及影响因素可发挥重要作用。近年来这类研究日益增加，这样的标准对指导和规范同类研究有重要意义。中华预防医学会将致力于推动我国公共卫生领域的团体标准建设工作蓬勃发展，助力健康中国战略实施。     

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。     

上海郊区自然人群队列和生物样本库建设

城镇化建设导致人口聚集、环境危险因素暴露风险增加和居民生活方式的改变, 人群间健康差异等问题也更加凸显。为了深入研究城镇化快速发展过程中居民慢性非传染性疾病(慢性病)的发病特点及变化趋势, 分析环境、生活方式和遗传等因素与主要慢性病的关系, 为慢性病的精准防控提供科学依据, 复旦大学公共卫生学院依托上海市"高峰学科建设项目", 自2016年4月起在城镇化快速发展的上海市松江、嘉定、闵行和徐汇区启动了"上海郊区自然人群队列和生物样本库"(SSACB)建设工作, 招募69 116名20～74岁常住居民作为队列成员。队列采用流行病学调查、体格检查和实验室检测等方法收集成员基本资料, 采集血、尿等标本建立生物标本库, 建立包括队列成员电子医疗病历系统、慢性病管理系统、肿瘤登记系统、传染病报告系统和死亡登记系统在内的区域健康信息共享平台。本文围绕SSACB队列设计理念、建设进程以及今后发展目标进行阐述。     

西北区域自然人群队列建设与实践

预防和控制慢性非传染性疾病(慢性病)是我国面临的重要公共卫生问题。西北区域自然环境独特, 人群健康状况与疾病特征具有鲜明的地域特色, 为了满足深入研究该地区慢性病病因、机制和转归的迫切需求, 根据西北区域特殊生态环境、人口规模和民族分布, 于2017-2019年在陕西省、甘肃省、青海省、宁夏回族自治区和新疆维吾尔自治区建立西北区域自然人群队列, 招募了117 644名35～74岁的多民族(汉族、回族、维吾尔族、哈萨克族和藏族)自然人群, 调查队列成员的个体、环境及社会等多方面的基线暴露信息, 采集外周血, 分离血浆、血清和白膜层, 形成各类生物样本90余万份, 以-80 ℃储存于标准生物样本库。已开始用常规监测和主动随访相结合的方式进行长期随访观察。队列成员的平均年龄52.43岁, 女性70 391名(59.8%), 不同民族间的社会经济状况和生活方式存在一定差异, 健康状况具有相似性但呈现出各自不同的特点。该队列为深入研究环境、生活方式及遗传因素与重要高发慢性病的关系提供了研究平台, 为明确该地区不同民族慢性病的病因及长期健康危害提供重要流行病学证据, 为国家制定慢性病防治战略提供西...     

我国基础营养研究进展与展望

<正>在过去的几年中,我国基础营养研究工作者瞄准国际营养科学前沿,围绕着影响我国居民健康的主要营养问题,在相关研究领域取得了系列重要的进展。1主要研究进展1.1中国人群代谢性疾病相关的遗传和营养因素、分子生物表型及潜在机制通过建立我国首个2型糖尿病全基因组关联研究(GWAS)数据库并在前瞻性流行病学队列研究中运用多组学手段,林旭研究员团队已发现多个与奶制品、碳水化合物、维生素D、必需脂肪     

社区营养健康教育的实践与体会

随着社会进步和经济的发展，人民的生活水平不断提高，社区居民的膳食结构也发生了相应的改变。但由于社区人群普遍缺乏有关营养学知识，使营养不良和与营养有关的慢性病的发病率与日俱增，营养与疾病的关系已经引起广泛关注。在少数民族地区社区居民中开展社区营养健康教育，针对不同人群的特殊营养需要和常见疾病的营养防治进行营养与膳食指导，在人群中建立起平衡营养与疾病的营养防治，以达到预防营养缺乏性疾病和某些常见慢性病的发生，提高社区人群的健康水平的目的。     

流行病学研究新进展

流行病学是一门方法学与应用科学相融合的学科,预防和控制疾病、促进健康是其学科使命。本研究从传染病、慢性病、系统流行病学、实施性研究和健康医疗大数据5个方面介绍流行病学的新进展。传染病领域的新工程与不断涌现的新技术令人振奋,同时病原体变异的环境影响因素需得到更多重视。慢性病领域需更加重视老年人群共病问题;感染性诱发因素、人体菌群在慢性病发生发展过程中的作用逐渐被揭示。系统流行病学是现代流行病学的新兴分支与重要补充,对实现精准预防具有重要意义。实施性研究是连接医学基础科研与公共卫生实践的桥梁,将为健康中国行动计划的有效落实提供证据支持。健康医疗大数据的发展以数字化公共卫生为基础,为流行病学提供广阔的科研平台和丰富的数据资源,也将推动公共卫生服务管理模式的根本转变。     

华西老年人群健康队列研究总体方案

我国是目前全球老龄化进程最快的国家之一,衰老相关的慢性非传染性疾病和退行性疾病导致的健康相关损伤是我国公共卫生体系将要面临的严峻挑战。华西老年人群健康队列拟通过建立以社区为基础的华西老年人群健康队列,由专职研究人员通过入户问卷调查、现场体格检查、生物样本收集、实验室检测相结合的方式进行样本数据收集,并进一步建立老年人群多模态精准医学亚队列,基于多组学方法角度,识别老年人环境、膳食、及遗传变异对衰老相关疾病的影响,为开展老年人群老龄化相关疾病高危人群筛查及疾病预防和控制相关靶点提供证据支持。可以为老年相关疾病防控、减轻疾病负担提供流行病学证据。本文对该队列的背景、目的、研究内容和方法进行简要介绍。     

The full bibliography of Ernst Ludwig Wynder

The chronology of lifetime publications authored and/or co-authored by Dr. Ernst L. Wynder spans a rich assortment of topics relating to the etiology and prevention of chronic diseases. Dr. Wynder's interdisciplinary approach to research in cancer and heart disease embraces the disciplines of epidemiology, biology, pathology, chemistry, biochemistry, tobacco sciences, and nutrition as well as health behavior, and health education. His works reflect his attention to diverse subjects from methodology in scientific endeavors, to mechanisms in carcinogenesis, brain development, alternative medicine, principles of disease prevention, history of medicine, and societal issues, as well as philosophy, and religion. In 1972 Dr. Wynder created the journal Preventive Medicine as an international forum for the exchange of ideas that address the promotion of health and prevention of disease in our time. Many of his ideas were developed and nurtured in the symposia and workshops the Journal has published.     

Survey of state health agencies' staff who practice the epidemiology of noninfectious diseases and conditions.

The primary causes of mortality in the United States are noninfectious diseases and conditions. Epidemiologic and intervention activities related to most of these diseases and conditions have increased in most State health agencies over the past decade. Because little was known of the practice of noninfectious disease epidemiology in State health agencies, a mail survey was undertaken in 1991. Persons working in State health agencies who responded to the survey had a graduate degree in epidemiology, biostatistics, or related fields and actively participated in the epidemiology of noninfectious diseases or conditions. Respondents were from 48 States, predominantly male (56 percent) and white (92 percent). On an average, respondents spent roughly half of their time actually doing epidemiology. The focus of noninfectious disease epidemiology has been categorized by risk factors (environment, occupation, nutrition, tobacco, and substance abuse), diseases (diabetes, cancer, and cardiovascular disease), and health conditions (injury, birth defects, and other reproductive conditions). The percentage of respondents who reported epidemiologic activity in any risk factor, disease, or condition varied from 55 percent for environmental epidemiology to 9 percent in nutritional epidemiology. Respondents from 41 States reported activity in environmental epidemiology, those from 18 States reported activity in substance-abuse epidemiology, and those from 13 States reported activity in nutritional epidemiology. Although the practice of noninfectious disease epidemiology appears to be considered important in the majority of States, the extent of practice varies markedly. Those risk factors, diseases, and conditions that are most frequently associated with morbidity and mortality are the least addressed epidemiologically in State health agencies.(ABSTRACT TRUNCATED AT 250 WORDS)     

上海市黄浦区社区居民健康大讲坛活动效果评价

目的评价以健康俱乐部为载体开展健康大讲坛活动对提高社区居民健康意识、相关预防和控制慢性病知识、改善不良行为方式所起的作用。方法采用现场调查、专题小组讨论和问卷调查的方法调查6家社区健康俱乐部的健康大讲坛的活动效果。结果共调查219名参与健康大进坛活动的社区居民,他们对健康大讲坛效果满意率为100%,参加健康大讲坛后,糖尿病相关知识得分均分为84.95分,合格率为84.48%,高血压相关知识得分均分为78.50分,合格率为93.20%,活动后社区居民慢性病知识知晓率均有所提高,与干预前比较具有统计学差异（P〈0.01）。结论健康俱乐部的健康大讲坛活动有助于人们较系统地获得相关健康知识和保健技能,并在管理者的指导下,逐步形成了健康生活方式。     

The role of epidemiology in determining when evidence is sufficient to support nutrition recommendations. Summary statement.

This statement summarizes the key points of discussion among a group of nutritional epidemiologists who met in Washington, DC, for 2 d in October of 1997 to reflect on the role of nutritional epidemiology in the development of dietary recommendations for the public. Although imprecision in the measurement of diet places limits on nutritional epidemiology, no other field of nutritional science can provide direct information on relations between nutrition and health in free-living human populations. Among the nutritional sciences, therefore, epidemiology was regarded as being critically important. Nutritional epidemiology can be improved in the future by the development of more precise measures of long-term dietary exposures, both by improved methods of self-reporting of diet and by the development of more useful biomarkers of long-term nutritional status. There is a need as well to reconsider the applicability of causal criteria as applied to nutritional epidemiology, because many of the important associations between dietary behaviors and chronic diseases cannot necessarily be expected to be either strong or to manifest linear dose-response relations. In the future, scientific evidence from the rapidly growing field of nutritional epidemiology will likely play an increasingly important role in developing nutrition policy and advice for the public.     

The Impact of RDNs on Non-Communicable Diseases: Proceedings from The State of Food and Nutrition Series Forum

In the United States, nutrition-related morbidities are rising steadily at rates corresponding to increasing overweight and obesity in the population. Such morbidities take huge tolls on personal health and impose high costs on health care systems. In 2019, the Academy of Nutrition and Dietetics (Academy) and the Academy of Nutrition and Dietetics Foundation (Academy Foundation) embarked on a new project titled “The State of Food and Nutrition Series” to demonstrate the value of nutrition interventions led by registered dietitian nutritionists for individuals with the following 3 high-priority non-communicable diseases that affect many in the United States and globally: type 2 diabetes mellitus, chronic kidney disease, and hypertension. Poor nutritional status contributes to disease onset and progression in these non-communicable diseases, and appropriate medical nutrition therapy can prevent or delay worsening and ameliorate poor health outcomes. However, many people who have these conditions do not have access to an registered dietitian nutritionist, and consequently do not receive the nutrition care they need. On February 19-20, 2020 in Arlington, VA, as the first stage in The State of Food and Nutrition Series, the Academy and the Academy Foundation gathered health care policymakers, clinicians, and researchers from across the country for the State of Food and Nutrition Series Forum, where Academy leaders sought input to build a comprehensive research strategy that will quantify the impact of patient access to registered dietitian nutritionist–led nutrition interventions for type 2 diabetes mellitus, chronic kidney disease, and hypertension. This article summarizes the findings of that forum.     

ACE forum report: the making of an epidemiologist--necessary components for doctoral education and training

The 2002 meeting of the American College of Epidemiology included an open forum on doctoral education and training in epidemiology. Discussion groups, facilitated by selected senior epidemiologists, recommended changes that would better prepare future epidemiologists to meet new challenges in public health and to build successful careers. The forum discussions were complemented by a panel of two doctoral students and two senior epidemiologists who provided their perspectives on each of the topics. Within discussion groups, agreement was clear on some issues and elusive on others. For example, good mentoring was considered a critical factor for a successful career, but how good mentoring can be promoted was a more complex issue. Likewise, experience with primary data collection should be a standard requirement for the doctoral degree, but the group's definition of primary data collection was more ambiguous. The recommendations derived from the education forum are summarized in this report, which may serve as an impetus for changes in the education and training of future epidemiologists.     

空间全生命周期流行病学在慢性病研究中的应用

近年来, 慢性病致病因素的研究从专注行为生活方式等非空间因素逐渐向地理环境等空间因素延伸。空间全生命周期流行病学是健康地理学的分支方向。作为全生命周期流行病学和空间流行病学的融合, 空间全生命周期流行病学结合先进的地理信息、测绘遥感、移动定位、人工智能等技术, 对个体的全生命周期暴露史(暴露组)进行精准回溯、测量及模拟, 采用累积风险模型和关键期/敏感期风险模型等全生命周期模型研究暴露史在个体全生命周期不同阶段对健康的影响。本文对空间全生命周期流行病学在慢性病研究中的理论基础、分析策略及重点研究内容进行综述, 旨在促进其在慢性病领域的致病因素研究中的应用, 为后续研究提供参考和建议, 推动健康地理学的发展, 最终实现全生命周期精准健康管理。     

Nutritional ecology: chances of public health services to shape procedures

Nutrition ecology is the science that studies the impacts of human nutrition on the environment, on human health and on social systems. Environmental impacts are usually the result of intensive food production, food transport and food packaging; they include soil contamination and erosion, energy consumption, air contamination and waste disposal. Health impacts of contemporary western eating behavior concern nutrition-related diseases (diabetes, hypertension, gout, overweight etc) and their psychological and social consequences; nutrition ecology aims at a balanced diet and suitable eating behavior to reduce the risks of chronic disease. The social impacts of nutrition concern the effects of feed trade on poor working conditions and poverty, especially in developing countries. The strategies of nutrition ecology agree in many points with those of the agenda 21 and of Consumer Protection. As nutrition-related diseases are increasing further, the public health services in Germany discover nutrition as an important topic in health promotion and prevention. They will contribute remarkably to a sustainable development if they include the strategies of nutrition ecology in their projects.     

部分媒体从业人员营养相关知识知晓情况及需求调查

目的了解部分媒体从业人员营养相关知识的知晓情况及需求,为开展营养健康传播提供科学依据。方法对全国范围内参与2013年“营养中国行”项目营养论坛的媒体从业人员开展问卷调查。结果共调查媒体从业人员105人,男性54人（51．4％）,女性51人（48．6％）。营养知识基本素养较低,“营养基础知识”全部回答正确率占37．1％,“《中国居民膳食指南》”全部回答正确率占8．6％。缺乏信息来源,或对信息来源不加甄别（68．6％）、报道以偏概全（50．5％）和过度强调单一食物的营养作用（40．0％）被认为是营养健康传播中最突出的3个问题;营养健康传播选题的主要依据是受众的需求（79．0％）;35．2％和47．6％的人会经常查证和逐条查证所传播信息的信源;47．6％的人比较了解受众的需求。83．8％和70．5％的人需要营养领域专家以及营养和健康教育专业机构的支持;63．8％的人希望专家用通俗易懂的语言传播营养健康知识;61．9％的人希望专业机构定期开展媒体和专家的沟通活动,并建立可查询的营养领域权威专家资源库。结论媒体从业人员营养知识还有不足,因此还需要健康教育和营养领域专业机构、媒体、营养专家和公众的通力合作。。