糖尿病流行病学研究策略及分子遗传学研究进展

流行病学是现代医学的一门重要的基础学科,也是一门应用广泛的应用学科。流行病学作为方法学在复杂疾病研究中有不可替代的作用。糖尿病具有复杂疾病属性,应该以系统的多层次的流行病学方法为研究策略。本文从流行病学与临床医学、遗传学及分子生物学交叉所形成的分支学科--临床流行病学、遗传流行病学及分子流行病学三个方面对糖尿病的研究进展作一综述,并从分子遗传学角度列举了部分糖尿病的候选基因。提出糖尿病的研究应该从宏观流行病学(如社会环境等因素的影响)和微观流行病学(如分子遗传等)结合系统地进行研究。     

The Epidemiology of Helicobacter pylori and Public Health Implications

This article presents a review of the literature on the epidemiology and public health implications of Helicobacter pylori infection published from April 2008 through to March 2009. The authors used MeSH terms "Helicobacter infections epidemiology,""Helicobacter infections prevention and control" to search multiple databases (PubMed, Embase, Cochrane, Cochrane Library, EBMR, BIOSIS), and independently searched PubMed using the term "Helicobacter" with "Epidemiology,""Transmission,""Prevalence" or "Environment." Articles without topical relevance were excluded. Two additional papers known to the authors were added. The identified literature is summarized by subtopic: reviews; prevalence; incidence; transmission; risk factors; and public health policy.     

Factors influencing the transferability of medical decision support systems

Transferability is a key issue in the development and implementation of medical decision support systems. Such systems have up to now tended to be confined to the development site. Transferability represents the integrated effect of several more basic attributes of Decision Support Systems. These attributes can be considered to belong to two main groups: those concerned with the Medical Domain (of the system) and those concerned with the Information Technology by which the System functions. Among the Domain issues the most important are: Epidemiology, Terminology and Methodology. Concerning the Information Technology issues the most important are: Knowledge Acquisition and Representation methods, Database design and integration with inference mechanism. The effect of each of the individual factors is considered by illustrations from the literature and by studying the results of recent experiments where databases and decision support systems from different countries are interchanged. This exercise allows some planning in the design of future systems with the aim of improving overall transferability and therefore applicability.     

Discussion on the problems of general epidemiology

The key problems of general epidemiology: the subject, method, causality in the epidemic process, the main categories and laws, the systematization of infectious pathology and epidemiological terminology are under discussion. It is at this stage when students should form valid notions, well grounded on scientific facts and practical experience, concerning the epidemiology of noninfectious diseases with due regard to the existing differences in the interpretation of the causes of the epidemic process in noninfectious diseases and to the characteristic distribution of noninfectious diseases among the population under the influence of environmental factors without any participation of parasitic systems. The review of the notion apparatus of the theoretical epidemiology and putting it in order in accordance with general biological concepts are proposed in connection with the necessity of differentiation between the epidemic process proper (in cases of anthroponosis) and the epidemic manifestations of epizoonotic and epiphytotic processes (in cases of zoonoses and sapronoses).     

Five Classic Articles in Public Health

In this brief review, Dr. Jonathan Borak comments on five seminal papers that helped shape the fields of epidemiology and public health. These papers include Hill’s criteria for inferring causality; the first proof of the multistage theory of cancer; the first evidence that subclinical lead exposures can cause neurobehavioral impairment in children; a simple yet robust study that had a major influence on setting current air pollution policies; and a landmark review of the general public’s perception of risk in relation to actual public health hazard.Dr. Jonathan Borak is a Clinical Professor of Epidemiology and Public Health at the Yale School of Public Health, Clinical Professor of Internal Medicine at the Yale School of Medicine, and Director of the Yale Interdisciplinary Risk Assessment Forum. In this article, Dr. Borak provides his perspective on five publications that significantly influenced the study and practice of epidemiology and public health. This article is the first in a series that will identify and provide commentary on the top five seminal papers published in a field related to biology and medicine.A former student, a member of the Yale Journal of Biology and Medicine’s Editorial Board, reminded me of a comment I made in class. I had described a particular assigned reading as “one of those classic articles” that should be read by everyone studying public health. Okay, he challenged me, what other “classic articles” were on my list? And so began the following: my short list of five articles that represent “must reading” for all students in public health.First, note that I do not speak for public health in general, a field of great breadth of interest and activity, but only the narrower slice, including toxicology, risk assessment, and related interests. Also, I was principally concerned to identify articles that provide models of critical thinking, addressed issues of substantial public health importance, and served as stepping stones for subsequent research and the formulation of public health policy. I also wanted to include articles that were observational and opportunistic, i.e., based on real world observations and available data, not complex laboratory models.My five choices below include: 1) a landmark presentation of criteria for inferring causality from observational data (Hill 1965); 2) a thought experiment based on the re-analysis of publicly available cancer mortality data, which shaped the fields of cancer biology and risk assessment (Armitrage & Doll, 1954); 3) an early study of the effects of lead exposure in school children (Needleman, 1979); 4) a study of the impact of air pollution on children’s health, which was enabled by a fortuitous labor dispute that shuttered a polluting steel mill (Ransom & Pope, 1992); and, 5) a critical literature review of cognitive psychology research that shaped our understanding about how public health risks are perceived (Slovic, 1987).     

Earth Observation,Spatial Data Quality,and Neglected Tropical Diseases

Earth observation (EO) is the use of remote sensing and in situ observations to gather data on the environment. It finds increasing application in the study of environmentally modulated neglected tropical diseases (NTDs). Obtaining and assuring the quality of the relevant spatially and temporally indexed EO data remain challenges. Our objective was to review the Earth observation products currently used in studies of NTD epidemiology and to discuss fundamental issues relating to spatial data quality (SDQ), which limit the utilization of EO and pose challenges for its more effective use. We searched Web of Science and PubMed for studies related to EO and echinococossis, leptospirosis, schistosomiasis, and soil-transmitted helminth infections. Relevant literature was also identified from the bibliographies of those papers. We found that extensive use is made of EO products in the study of NTD epidemiology; however, the quality of these products is usually given little explicit attention. We review key issues in SDQ concerning spatial and temporal scale, uncertainty, and the documentation and use of quality information. We give examples of how these issues may interact with uncertainty in NTD data to affect the output of an epidemiological analysis. We conclude that researchers should give careful attention to SDQ when designing NTD spatial-epidemiological studies. This should be used to inform uncertainty analysis in the epidemiological study. SDQ should be documented and made available to other researchers.     

糖尿病流行病学研究策略及分子遗传学研究进展

流行病学是现代医学的一门重要的基础学科,也是一门应用广泛的应用学科。流行病学作为方法学在复杂疾病研究中有不可替代的作用。糖尿病具有复杂疾病属性,应该以系统的多层次的流行病学方法为研究策略。本文从流行病学与临床医学、遗传学及分子生物学交叉所形成的分支学科一临床流行病学、遗传流行病学及分子流行病学三个方面对糖尿病的研究进展作一综述,并从分子遗传学角度列举了部分糖尿病的候选基因。提出糖尿病的研究应该从宏观流行病学（如社会环境等因素的影响）和微观流行病学（如分子遗传等）结合系统地进行研究。     

儿童幽门螺杆菌感染

幽门螺杆菌感染不仅能引起胃炎、消化性溃疡,诱发胃癌等胃肠道的病变,还与许多胃肠外疾病密切相关,如果不经过特殊治疗将终生带菌,严重的影响小儿的生长发育和身心健康。这些问题引起了儿科医生和儿童保健医生的共同关注。儿童期既是幽门螺杆菌感染的特殊时期,也是控制感染的关键时期。本文将从小儿幽门螺杆菌国内外的感染状况、相关疾病、诊断方法、治疗及预防等几个方面综述如下。     

Vaccination: the present and the future

Vaccines have undoubtedly saved the lives of millions, and along with improved sanitation, they remain one of the cornerstones of modern medicine. Many diseases that were once widespread are now eradicated, but vaccine programs face ongoing challenges. Safety concerns as well as limited funding have led to pockets of reduced vaccine coverage around the world - including in developed countries. Chronic and recurrent diseases such as human immunodeficiency virus (HIV), tuberculosis, and malaria remain without effective vaccines. This review will briefly describe vaccines and the two major issues faced by modern vaccination programs: insufficient vaccine coverage and developing effective vaccines for chronic and recurrent diseases.     

Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology,mechanisms and management

Populations with common physical diseases – such as cardiovascular diseases, cancer and neurodegenerative disorders – experience substantially higher rates of major depressive disorder (MDD) than the general population. On the other hand, people living with MDD have a greater risk for many physical diseases. This high level of comorbidity is associated with worse outcomes, reduced adherence to treatment, increased mortality, and greater health care utilization and costs. Comorbidity can also result in a range of clinical challenges, such as a more complicated therapeutic alliance, issues pertaining to adaptive health behaviors, drug-drug interactions and adverse events induced by medications used for physical and mental disorders. Potential explanations for the high prevalence of the above comorbidity involve shared genetic and biological pathways. These latter include inflammation, the gut microbiome, mitochondrial function and energy metabolism, hypothalamic-pituitary-adrenal axis dysregulation, and brain structure and function. Furthermore, MDD and physical diseases have in common several antecedents related to social factors (e.g., socioeconomic status), lifestyle variables (e.g., physical activity, diet, sleep), and stressful live events (e.g., childhood trauma). Pharmacotherapies and psychotherapies are effective treatments for comorbid MDD, and the introduction of lifestyle interventions as well as collaborative care models and digital technologies provide promising strategies for improving management. This paper aims to provide a detailed overview of the epidemiology of the comorbidity of MDD and specific physical diseases, including prevalence and bidirectional risk; of shared biological pathways potentially implicated in the pathogenesis of MDD and common physical diseases; of socio-environmental factors that serve as both shared risk and protective factors; and of management of MDD and physical diseases, including prevention and treatment. We conclude with future directions and emerging research related to optimal care of people with comorbid MDD and physical diseases.     

巴尔通体感染性心内膜炎的研究进展

感染性心内膜炎一直是威胁人类健康的重要疾病之一。近年来人类正面临着此病发病率持续上升的局面,其诊断、治疗和预防依然是目前需要解决的重要临床和公共卫生问题。本文介绍了感染性心内膜炎疾病的最新研究进展,分析了国内外报道的538份巴尔通体感染性心内膜炎的病例,重点阐述了巴尔通体和相关心内膜炎的流行病学、实验室诊断、治疗以及发病的危险因素和预防控制措施。预测这些研究将对人类理解和控制巴尔通体感染性心内膜炎具有重要的指导意义。     

Cultural Specificity and Comparison in Psychiatric Epidemiology: Walking the Tightrope in American Indian Research

Increasingly, the mental health needs of populations are measured using large-sample surveys with standardized measures and methods. Such efforts, however, rarely include sufficient number of smaller, culturally defined populations to draw defensible conclusions about their needs. Furthermore, without some adaptation, the standardized methods and measures may yield invalid results in such populations. Using a recently completed psychiatric epidemiology and services study with American Indian populations as a case example, this paper outlines issues facing epidemiologists working in such culturally diverse contexts. The issues discussed include the following: (1) persuading the scientific community and potential sponsors that work with distinct or culturally defined populations is important; (2) framing research questions and activities to meet the needs of communities; (3) defining a population of inference; (4) balancing the needs for comparability and cultural specificity; (5) maximizing scientific validity in light of the challenges in sample acquisition; and (6) developing and implementing data collection methods that uphold scientific standards but are also realistic given the context. The authors draw on their experiences—most recently in the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP)—to illustrate these issues and suggest ways to address each. A goal of this paper is to challenge those invested in conducting culturally valid epidemiologic work in such populations to better articulate the nature of these efforts.     

Diseases of echinoderms

Diseases of echinoderms are poorly documented. Most reports concern biotic diseases caused by animal agents. While parasites on echinoderms have been described in increasing numbers of papers for more than one century, the host-parasite relationship and the effects of parasitism on echinoderm life-cycles were rarely considered. The parasitic fauna differs markedly according to the echinoderm group concerned, depending on various factors such as feeding-habits or symbiogenesis. Microorganismic diseases undoubtedly occur in echinoderms but they were not investigated until recently. Microorganisms have frequently been assumed to act as agents causing mass mortalities. As for stress-caused diseases, the only — and very preliminary — data available concern almost exclusively those induced by pollution. Since echinoderms are major components of benthic ecosystems, echinoderm diseases may be expected to exert prominent ecological effects.     

The rationing agenda in the NHS. Rationing Agenda Group.

The Rationing Agenda Group has been founded to deepen the British debate on rationing health care. It believes that rationing in health care is inevitable and that the public must be involved in the debate about issues relating to rationing. The group comprises people from all parts of health care, none of whom represent either their group or their institutions. RAG has begun by producing this document, which attempts to set an agenda of all the issues that need to be considered when debating the rationing of health care. We hope for responses to the document. The next stage will be to incorporate the responses into the agenda. Then RAG will divide the agenda into manageable chunks and commission expert, detailed commentaries. From this material a final paper will be published and used to prompt public debate. This stage should be reached early in 1997. While these papers are being prepared RAG is developing ways to involve the public in the debate and evaluate the whole process. We present as neutrally as possible all the issues related to rationing and priority setting in the NHS. We focus on the NHS for two reasons. Firstly, for those of us resident in the United Kingdom the NHS is the health care system with which we are most familiar and most concerned. Secondly, focusing on one system alone allows more coherent analysis than would be possible if issues in other systems were included as well. Our concern is with the delivery of health care, not its finance, though we discuss the possible effects of changing the financing system of the NHS. Finally, though our position is neutral, we hold two substantive views--namely, that rationing is unavoidable and that there should be more explicit debate about the principles and issues concerned. We consider the issues under four headings: preliminaries, ethics, democracy, and empirical questions. Preliminaries deal with the semantics of rationing, whether rationing is necessary, and with the range of services to which rationing relates. Under ethics and democracy are the substantive issues of principle and theory. The final section deals with empirical questions and those relating to the practicality of various strategies.     

真菌学报创刊十周年纪念*

《真菌学报》自1982年创刊以来已10年,共发行10卷38期和1增刊,约450万字;刊登论文487篇,其中用英文撰写的85篇,占17.5%;简报34篇,占6.9%。发表菌物新属2个,新种413个,中国新记录种645个。论文主要内容涉及菌物的分类和资源、形态和超微结构、生态和区系、生理和遗传、应用菌物学和生物技术,以及病理学和综述等。对我国菌物学的发展起了促进作用。     

真菌学报创刊十周年纪念

《真菌学报》自1982年创刊以来已10年,共发行10卷38期和1增刊,约450万字;刊登论文487篇,其中用英文撰写的85篇,占17.5%;简报34篇,占6.9%。发表菌物新属2个,新种413个,中国新记录种645个。论文主要内容涉及菌物的分类和资源、形态和超微结构、生态和区系、生理和遗传、应用菌物学和生物技术,以及病理学和综述等。对我国菌物学的发展起了促进作用。     

Epidemiology and heat waves: analysis of the 2003 episode in France

Epidemiology and heat waves: analysis of the 2003 episode in France. The heat wave that struck France in 2003 has been accompanied with an estimated 15,000 excess deaths. This paper stresses the difficulties of the epidemiology of such an event. The relevant clinical and biological information is incomplete or even inaccessible and many of the deaths are due to multiple factors. The data presently available indicate that the deaths occurred in persons already vulnerable, and that the heat wave caused a five- to eight-month loss of lifetime for the affected individuals. There is a noteworthy similarity between the profiles of this exceptional summer mortality surge, and those of many past winters when similar or larger excess mortalities ave occurred without as yet eliciting much public attention.     

Passing on the legacy: teaching capillary filtration and developing presentation skills using classic papers

Capillary filtration is a key area in the understanding of cardiovascular function and has both physiological and pathophysiological relevance in nearly every organ system. This article describes how classic papers in the Legacy collection of American Physiological Society publications can be used in a teaching symposium exploring the evidence supporting current concepts of capillary fluid exchange. Individual students are given papers to read, edit, and present to the class. The appropriate selection and sequencing of these papers allows the development of important physiological concepts to be tracked. A series of papers concerned with capillary filtration is suggested, and the contribution of each to the developing story is outlined. This approach allows students to develop critical and presentation skills and provides them with a case study of the scientific method as it is applied to physiology as well as establishing an appropriate knowledge base concerning the role of hydrostatic and oncotic forces in capillary fluid exchange. Relevant teaching points are explored further using questions based on a figure from one of the three classic papers used: "Microinjection studies of capillary permeability: II. The relationship between capillary pressure and the rate at which fluid passes through the walls of single capillaries," by E. M. Landis (Am J Physiol 82: 217-238, 1927).