Eaton William
Department of Mental Hygiene, Johns Hopkins University, Baltimore, MD, USA.
Ann Epidemiol. 2002 Oct;12(7):445-51. doi: 10.1016/s1047-2797(01)00314-3.
This article proposes that the nation undertake a study of a cohort which will be followed from pregnancy to death- a research project that will require more than 100 years. The project would take advantage of the recent completion of the human genome study, the accelerating development of new non-invasive measurement technologies, as well as new information about the complexity and long duration of the causal period for diseases. This complexity involves increasing awareness of long developmental processes which do not fit the typical picture of disease and that do not always have an obvious demarcation of disease onset. Appreciation for the complexity of the web of causation has expanded as the human genome project has unfolded, because it has become increasingly apparent how intimately the action of genetic material depends on contingencies of the individual interacting with the environment; and that the chances of discovering the action of genes, singly or in clusters, will be greatly enhanced by the ability to characterize the environment during distinct developmental periods. Likewise, the ability to understand environmental influences will depend on knowledge of genes. Additionally, there is new evidence for here-to-fore unsuspected comorbidities, the understanding of which would be greatly benefitted by a conception-to-death cohort study with a broad range of health outcomes. In many cases these developmental processes, contingencies, and comorbidities involve long causal periods, approaching that of the entire human lifespan. A conception-to-death cohort study would provide information on disease, human development, environmental risk and protective factors, and public health that will not be achievable by any other research design.
本文提议国家开展一项对一组人群从孕期到死亡的跟踪研究——这是一个需要100多年时间的研究项目。该项目将利用人类基因组研究的近期成果、新型非侵入性测量技术的加速发展，以及有关疾病因果期复杂性和长期性的新信息。这种复杂性包括人们越来越意识到漫长的发育过程，这些过程不符合典型的疾病模式，而且疾病发作往往没有明显的界限。随着人类基因组计划的展开，人们对因果关系网络复杂性的认识不断扩展，因为越来越明显的是，遗传物质的作用与个体与环境相互作用的偶然性密切相关；而且，通过在不同发育阶段表征环境的能力，发现单个或成簇基因作用的机会将大大增加。同样，理解环境影响的能力将取决于对基因的了解。此外，有新证据表明存在此前未被怀疑的共病情况，对这些情况的理解将通过一项涵盖广泛健康结果的从受孕到死亡的队列研究而大大受益。在许多情况下，这些发育过程、偶然性和共病情况涉及漫长的因果期，接近整个人类寿命。一项从受孕到死亡的队列研究将提供有关疾病、人类发育、环境风险和保护因素以及公共卫生的信息，而这些信息是任何其他研究设计都无法获得的。
