重视群体和亚群体精准营养的研究

精准营养是基于遗传、生理代谢、生活特征、环境暴露等因素提出的“量体裁衣”的膳食措施。精准营养并非是为每个个体研发与其他所有个体不同的营养处方,而是更需要从群体、亚群体维度探讨精准营养的膳食措施,达到促进健康和降低慢性病风险的目的。     

环境流行病学:多学科交叉多层次研究

一、环境流行病学的特点和面临的挑战根据美国NationalResearchCouncil对环境流行病学的定义[1],环境流行病学并不是证实特定环境因素是否为某一疾病或健康效应的病因 ,而是证实特定环境因素与一个或多个特定健康效应之间的相关关系。总之 ,环境流行病学是研究个体的居住环境对健康的影响 ,而非个体的个性或者生活方式等因素对健康的影响。因此环境流行病学有其独特性 ,主要表现为 :①暴露于环境有害因素的人群很大 ;②环境暴露为低浓度混合暴露 ,且在肿瘤和其他慢性病的研究中 ,暴露可能发生在很久以前 ;③所研究的暴露通常是非自愿暴露 …     

基于剂量-反应模型的苯职业暴露健康风险定量评价方法研究

目的 初步建立一种评价职业暴露导致的健康风险的定量方法,为我国职业健康风险的定量研究提供理论依据.方法 根据健康风险评价的基本方法,利用剂量-反应模型计算个体暴露于剂量为d的某物质所导致的致癌概率.暴露物质的人体内剂量与致癌概率间的函数关系可用probit模型、logit模型、Weibull模型、单击模型、多击模型和多阶模型来表达.通过药代动力学分析或人类流行病学数据拟合,可以得到暴露剂量与人体内剂量间的函数关系,将其带入剂量-反应模型,即可得出不同环境浓度下暴露人群的致癌风险.结果 根据测得的环境苯浓度值,分别用2阶模型、单击模型和Weibull模型计算得到的剂量-反应曲线均为直线,2阶模型得出的致癌风险最高,Weibull模型得出的致癌风险最小,苯的平均浓度为7.25 mg/m3时,3个模型对应的风险值分别为7.50×10-4、1.83×10-4、2.31×10-6.结论 初步建立了一种定量评价职业健康风险的方法,可利用此方法对工作场所中的有害物质暴露情况进行分析,得出工人在此环境下的致癌风险.     

疾病风险评分在药物流行病学研究中的应用

疾病风险评分通过平衡不同组间研究对象的基线疾病风险以控制高维数据结构中的混杂效应,从而减小暴露因素效应估计的偏倚,因此在利用医疗数据库探索药物疗效或不良反应等规律的药物流行病学研究中有重要的应用价值。尽管疾病风险评分方法在很多情况下具有与倾向性评分相似的作用,而且在一些特殊暴露条件的研究中具有倾向性评分与传统混杂控制方法不可比拟的优势,但目前疾病风险评分在药物流行病学研究中应用范围远不及倾向性评分广泛。基于对疾病风险评分方法在药物流行病学研究中应用价值的考量,本文阐述了疾病风险评分的原理、模型构建、评分估计和应用的方法,以期为疾病风险评分方法在药物流行病学研究中的应用提供参考。     

隐Markov模型及其在慢性病流行病学研究中的应用

目的 探讨隐Markov模型在慢性病流行病学研究领域中的应用.方法 以2型糖尿病为例,应用多状态隐Markov模型对2型糖尿病的影响因素进行分析.结果 采用隐Markov模型分析2型糖尿病不同发展阶段的影响因素取得了较为满意的效果.结论 隐Markov模型是探讨慢性病影响因素的有效工具,在慢性病流行病学研究中具有广阔的应用前景.     

限制性立方样条在Cox比例风险回归模型中的应用

限制性立方样条Cox比例风险回归模型分析是流行病学多因素生存分析的重要方法。本研究通过对典型Cox比例风险回归模型和限制性立方样条Cox比例风险回归模型比较,阐述了典型Cox比例风险回归模型的局限性,以及限制性立方样条Cox比例风险回归模型基本原理与实现过程。在随访数据不满足典型Cox比例风险回归模型应用条件时,可采用该方法实现连续性暴露与结局之间的关联分析。     

基于基因与环境交互作用的儿童肥胖病因研究进展

儿童肥胖是全球性的公共健康问题,不仅危害儿童自身健康,还是成年期慢性病发病的重要诱因。近年来,随着精准医学研究的深入开展,越来越多的研究证据指明环境、行为因素,如早期宫内环境、儿童饮食、体力活动等,与儿童自身基因风险对肥胖的发病具有显著的交互作用,可以促进或抑制儿童肥胖的发生发展。本文对该领域现有研究进行综述,总结基因风险和环境暴露因素对儿童肥胖发病的交互作用及潜在机制,为不同遗传背景儿童的肥胖精准防控提供参考依据。     

基于AHP-BP神经网络的社区卫生服务中心慢性病管理能力风险评估研究

目的 了解山东省A市社区卫生服务中心慢性病管理能力风险现状，评估社区卫生服务中心慢性病管理能力风险，提出慢性病管理能力优化策略。方法 在A市分层随机抽取29所社区卫生服务中心，以现场调查的方式收集资料；运用层次分析法(analytic hierarchy process, AHP)和四分图模型描述风险现状；基于AHP-BP神经网络评估慢性病管理能力风险。结果 投入风险因素风险值排在前三位的分别是信息资源、人力资源和科室设置；产出风险中风险因素风险值最高的是慢性病康复。四分图模型分析结果显示4个风险因素分布在优势区，修补区、机会区和维持区分别有2个风险因素。评价结果显示该市整体社区卫生服务中心慢性病管理能力风险评价值为6.6245,处于中等风险水平，存在中度风险，但偏向高风险。结论 该市社区卫生服务中心慢性病管理能力风险已偏向高风险水平，应从制度-管理-个体层面全方位实行应急改善措施，以降低其慢性病管理能力存在的风险，满足居民慢性病管理需求。     

预防医学发展的国家战略需求及其关键前沿基础科学问题

国家自然科学基金委员会近日在北京召开第192期双清论坛，围绕"营养与健康"、"慢性病流行病学"及"环境与健康"展开研讨。在营养与健康领域，专家建议建立符合我国人群特点的膳食模式来防治慢性病和代谢性疾病。围绕慢性病流行病学，专家强调大型自然人群队列在支撑精准预防国家战略上的重要意义以及利用大队列开展基因-环境交互作用的研究。环境与健康领域着重讨论了环境暴露的表观跨代传递及子代对环境应答的调控机制。此次双清论坛结合国家战略需求，总结了预防医学发展的关键前沿基础科学问题。     

铸造作业工人职业接触与健康损害研究进展

铸造业职业危害因素复杂,其所致不良健康结局多样。铸造业有害因素的特点是低粉尘浓度、多种不同浓度毒物与高噪声强度等物理因素共存,其主要健康损害为矽肺、慢性支气管炎、职业性哮喘、铁尘肺、皮炎、心血管疾病、锰中毒等。职业流行病学研究表明铸造作业有致癌风险。国内既往的流行病学研究多为现况调查,队列研究较少,特别是测定的职业有害因素种类单一,尚未系统测定过铸造作业工人PAHs的暴露水平,也缺乏对个体多因素暴露的定量评价,因此难以对铸造作业中一些有害因素的低剂量、长期暴露的职业危害进行评价,也尚未将铸造业致癌风险评价纳入职业危害法制管理的范围。     

Improving longitudinal research in geospatial health: An agenda

All aspects of public health research require longitudinal analyses to fully capture the dynamics of outcomes and risk factors such as ageing, human mobility, non-communicable diseases (NCDs), climate change, and endemic, emerging, and re-emerging infectious diseases. Studies in geospatial health are often limited to spatial and temporal cross sections. This generates uncertainty in the exposures and behavior of study populations. We discuss a research agenda, including key challenges and opportunities of working with longitudinal geospatial health data. Examples include accounting for residential and human mobility, recruiting new birth cohorts, geoimputation, international and interdisciplinary collaborations, spatial lifecourse studies, and qualitative and mixed-methods approaches.     

加强老年流行病研究 科学指导老年健康防控

我国目前面临着严峻的人口老龄化和高龄化形势,老年人特别是高龄老人作为我国人口中寿命最长和最脆弱的特殊群体,亟需针对此人群开展深入的科学研究。老年流行病学是研究流行病学理论与方法在老年人研究中的应用科学,整合多种方法开展老年人特殊健康特征分析,获取老年人健康流行病学规律。本期“老年流行病学”重点号文章围绕老年人群慢性病、...     

我国流行病学学科发展70年的历程与成就

流行病学是在人类预防疾病和促进健康的实践中发展起来的一门学科,是公共卫生与预防医学的骨干学科。新中国成立70年来,随着人类疾病谱的变化和医学模式的转变,流行病学的应用范围由传染性疾病扩展到慢性非传染性疾病、伤害和其他健康相关领域。流行病学在疾病防控、科研教学、学会建设和期刊发展等方面取得了显著成就。本文拟梳理和概括我国流行病学学科发展历程,展示我国流行病学领域70年来的成就和贡献,探讨未来流行病学的学科发展方向,为我国流行病学学科发展留下历史印迹。     

A Lifecourse Approach to Health Development: Implications for the Maternal and Child Health Research Agenda

Lifecourse-informed models of health fundamentally challenge simple biomedical models, introducing new ways of thinking about how diseases develop. This paper considers the broad implications of lifecourse theory for the maternal and child health (MCH) research agenda. The Lifecourse Health Development model provides an organizing framework for a synthesis of the existing literature on lifecourse health and identification of gaps in knowledge. Priority areas identified for MCH research in order to close these knowledge gaps include: epigenetic mechanisms and their potential mutability; peri-conception as a critical and sensitive period for environmental exposures; maternal health prior to pregnancy; the role of the placenta as an important regulator of the intra-uterine environment; and ways to strengthen early mother–child interactions. Addressing knowledge gaps will require an emphasis on longitudinal rather than cross-sectional studies, long-term (lifetime) rather than short-term perspectives, datasets that include socio-demographic, biologic and genetic data on the same subjects rather than discipline-specific studies, measurement and study of positive health as well as disease states, and study of multi-rather than single generational cohorts. Adoption of a lifecourse-informed MCH research agenda requires a shift in focus from single cause-single disease epidemiologic inquiry to one that addresses multiple causes and outcomes. Investigators need additional training in effective interdisciplinary collaboration, advanced research methodology and higher-level statistical modeling. Advancing a life course health development research agenda in MCH will be foundational to the nation’s long-term health.     

Building an inter-disciplinary science of health inequalities: the example of lifecourse research

Across the post-industrial world, new public health strategies are being developed with the goal of reducing the socio-economic gradient in health. These new strategies are distinguished by a commitment to tackling the macro determinants of health inequalities through policies informed by scientific evidence. The engagement with macro determinants and with scientific evidence presents a major challenge to the health inequality research community. This is not only because of the complexity of the links between distal causes, proximal risk factors and health outcomes. It is also and more importantly because of the narrow disciplinary base of health inequality research. Grounded in social epidemiology, health inequality research has illuminated the pathways which run from individual socio-economic position to health-but has left in shadow the factors which influence socio-economic position. Broadening the evidence base to include these structural processes requires a new science of health inequalities, resourced both by epidemiological research and by research on social inequality and social exclusion. The paper demonstrates how such an inter-disciplinary science can be constructed. Taking lifecourse research as its example and the UK as its case study, it nests epidemiological research within social policy research: setting evidence on the health consequences of cumulative exposures within research on lifecourse dynamics, and locating both within analyses of how state policies can amplify or moderate inequalities in socio-economic position.     

我国慢性病管理现状、问题及发展建议

慢性非传染性疾病对我国居民健康造成较大威胁,慢性病管理工作是我国卫生工作的重点。本文通过文献和相关政策研究,从宏观—政策,中观—组织机构间的协调,微观—患者和人群三个层面对我国慢性病管理工作进程进行梳理归纳,并立足我国慢性病管理实际提出我国慢性病管理仍存在的一些问题。建议未来的慢性病管理工作应注重提炼慢性病管理理论模型;结合医改分级诊疗工作的推行,构建整合式慢性病管理服务网络;加快提升慢性病管理"终端"能力建设。     

Life-course approaches to inequalities in adult chronic disease risk

A life-course approach to chronic-disease epidemiology uses a multidisciplinary framework to understand the importance of time and timing in associations between exposures and outcomes at the individual and population levels. Such an approach to chronic diseases is enriched by specification of the particular manner in which timing in relation to physical growth, reproduction, infection, social mobility, behavioural transitions etc. can influence various adult chronic diseases in different ways, and more ambitiously by how these temporal processes are interconnected and manifested in health inequalities within a population and in population-level disease trends. The paper will discuss some historical background to life-course epidemiology and theoretical models of life-course processes, and will review some of the empirical evidence linking life-course processes to CHD, haemorrhagic stroke, stomach cancer and other chronic diseases in adulthood. It will also underscore that a life-course approach offers a way to conceptualize how underlying socio-environmental determinants of health, experienced at different life-course stages, can differentially influence the development of chronic diseases, as mediated through proximal specific biological processes.     

Prisoners of the proximate: loosening the constraints on epidemiology in an age of change.

"Modern epidemiology" has a primary orientation to the study of multiple risk factors for chronic noncommunicable diseases. If epidemiologists are to understand the determinants of population health in terms that extend beyond proximate, individual-level risk factors (and their biological mediators), they must learn to apply a social-ecologic systems perspective. The mind-set and methods of modern epidemiology entail the following four main constraints that limit engagement in issues of wider context: 1) a preoccupation with proximate risk factors; 2) a focus on individual-level versus population-level influences on health; 3) a typically modular (time-windowed) view of how individuals undergo changes in risk status (i.e., a life-stage vs. a life-course model of risk acquisition); and 4) the, as yet, unfamiliar challenge of scenario-based forecasting of health consequences of future, large-scale social and environmental changes. The evolution of the content and methods of epidemiology continues. Epidemiologists are gaining insights into the complex social and environmental systems that are the context for health and disease; thinking about population health in increasingly ecologic terms; developing dynamic, interactive, life-course models of disease risk acquisition; and extending their spatial-temporal frame of reference as they perceive the health risks posed by escalating human pressures on the wider environment. The constraints of "the proximate" upon epidemiology are thus loosening as the end of the century approaches.     

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。     

基于复杂网络理论的健康相关行为与慢性非传染性疾病关系研究进展

近年来,有关健康相关行为（健康行为）与慢性非传染性疾病（慢性病）的研究视角从专注多种健康行为与某个慢性病间“多因单果”的独立效应,逐渐转向多个健康行为与慢性病“多因多果”的复杂相互作用。复杂网络理论是系统科学的重要板块,该理论考虑了众多因素在同一网络中的博弈关系,可通过一系列复杂网络模型、指标,揭示健康行为与慢性病多个因素间如何相互作用。本文对复杂网络理论定义、发展及其在健康行为与慢性病领域的常用模型和指标、案例内容进行综述,旨在打开复杂网络理论在健康领域更广阔的运用场景,为后续健康行为与慢性病关系的研究提供可参考的思路和工具。