Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri 63110, USA.
Annu Rev Public Health. 2010;31:105-20. doi: 10.1146/annurev.publhealth.121208.131051.
Several key factors bear on the interpretation of prevention trials and observational studies that inform prevention strategies. These factors include the underlying disease process and aspects of the intervention: sustainability of behavior change, the time course of the intervention within the disease process, dose and duration of exposure needed to effect risk reduction, durability of the impact of intervention, and methodological problems in implementing and interpreting randomized trials and observational studies to evaluate prevention strategies. The question asked through an intent-to-treat analysis of a randomized controlled trial (RCT) differs from that in the observational setting. Furthermore, the long duration necessary to conduct prevention trials and the resulting lack of adherence to therapy can bias results toward the null. A broader range of approaches to evaluate prevention interventions and programs with improved knowledge synthesis and translation to public health practice will speed our progress toward achieving public health and prevention of chronic diseases.
有几个关键因素影响着预防试验和观察性研究的解读，这些研究为预防策略提供了信息。这些因素包括潜在的疾病过程和干预措施的各个方面：行为改变的可持续性、干预措施在疾病过程中的时间进程、减少风险所需的暴露剂量和持续时间、干预措施影响的持久性，以及在实施和解释随机试验和观察性研究以评估预防策略时的方法学问题。通过对随机对照试验（RCT）的意向性治疗分析提出的问题与观察性研究不同。此外，进行预防试验所需的长时间以及由此导致的治疗依从性差可能会使结果偏向无效。采用更广泛的方法来评估预防干预措施和计划，并进行更好的知识综合和转化，将加速我们在实现公共卫生和预防慢性病方面的进展。
