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Vidyya, from the Sanskrit "vaidya," a practitioner who has come to understand the science of life.

Volume 1 Published - 14:00 UTC    08:00 EST    27-May-2000      
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Association of Coffee and Caffeine Intake With the Risk of Parkinson Disease

G. Webster Ross, MD; Robert D. Abbott, PhD; Helen Petrovitch, MD; David M. Morens, MD; Andrew Grandinetti, PhD; Ko-Hui Tung, MS; Caroline M. Tanner, MD, PhD; Kamal H. Masaki, MD; Patricia L. Blanchette, MD, MPH; J. David Curb, MD, MPH; Jordan S. Popper, MD; Lon R. White, MD, MPH

Context  The projected expansion in the next several decades of the elderly population at highest risk for Parkinson disease (PD) makes identification of factors that promote or prevent the disease an important goal.

Objective  To explore the association of coffee and dietary caffeine intake with risk of PD.

Design, Setting, and Participants  Data were analyzed from 30 years of follow-up of 8004 Japanese-American men (aged 45-68 years) enrolled in the prospective longitudinal Honolulu Heart Program between 1965 and 1968.

Main Outcome Measure  Incident PD, by amount of coffee intake (measured at study enrollment and 6-year follow-up) and by total dietary caffeine intake (measured at enrollment).

Results  During follow-up, 102 men were identified as having PD. Age-adjusted incidence of PD declined consistently with increased amounts of coffee intake, from 10.4 per 10,000 person-years in men who drank no coffee to 1.9 per 10,000 person-years in men who drank at least 28 oz/d (P<.001 for trend). Similar relationships were observed with total caffeine intake (P<.001 for trend) and caffeine from noncoffee sources (P=.03 for trend). Consumption of increasing amounts of coffee was also associated with lower risk of PD in men who were never, past, and current smokers at baseline (P=.049, P=.22, and P=.02, respectively, for trend). Other nutrients in coffee, including niacin, were unrelated to PD incidence. The relationship between caffeine and PD was unaltered by intake of milk and sugar.

Conclusions  Our findings indicate that higher coffee and caffeine intake is associated with a significantly lower incidence of PD. This effect appears to be independent of smoking. The data suggest that the mechanism is related to caffeine intake and not to other nutrients contained in coffee.

JAMA. 2000;283:2674-2679

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Violence in G-Rated Animated Films

Fumie Yokota, MS; Kimberly M. Thompson, ScD

Context  Children's exposure to violence in the media is a possible source of public health concern; however, violence in children's animated films has not been quantified.

Objective  To quantify and characterize violence in G-rated animated feature films.

Design  Violence content was reviewed for all 74 G-rated animated feature films released in theaters between 1937 and 1999, recorded in English, and available for review on videocassette in the United States before September 1999.

Main Outcome Measures  Duration of violent scenes, type of characters participating in violent acts (good, neutral, or bad), number of injuries/fatalities, and types of weapons used for each film.

Results  All 74 films reviewed contained at least 1 act of violence (mean duration, 9.5 minutes per film; range, 6 seconds–24 minutes). Analysis of time trends showed a statistically significant increase in the duration of violence in the films with time (P=.001). The study found a total of 125 injuries (including 62 fatal injuries) in 46 (62%) of the films. Characters portrayed as "bad" were much more likely to die of an injury than other characters (odds ratio, 23.2; 95% confidence interval, 8.5-63.4). A majority of the violence (55%) was associated with good or neutral characters dueling with bad characters (ie, using violence as a means of reaching resolution of conflict), and characters used a wide range of weapons in violent acts.

Conclusions  Our content analysis suggests that a significant amount of violence exists in animated G-rated feature films. Physicians and parents should not overlook videocassettes as a source of exposure to violence for children.

JAMA. 2000;283:2716-2720

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What Makes Clinical Research Ethical?

Ezekiel J. Emanuel, MD, PhD; David Wendler, PhD; Christine Grady, PhD

Many believe that informed consent makes clinical research ethical. However, informed consent is neither necessary nor sufficient for ethical clinical research. Drawing on the basic philosophies underlying major codes, declarations, and other documents relevant to research with human subjects, we propose 7 requirements that systematically elucidate a coherent framework for evaluating the ethics of clinical research studies: (1) value—enhancements of health or knowledge must be derived from the research; (2) scientific validity—the research must be methodologically rigorous; (3) fair subject selection—scientific objectives, not vulnerability or privilege, and the potential for and distribution of risks and benefits, should determine communities selected as study sites and the inclusion criteria for individual subjects; (4) favorable risk-benefit ratio—within the context of standard clinical practice and the research protocol, risks must be minimized, potential benefits enhanced, and the potential benefits to individuals and knowledge gained for society must outweigh the risks; (5) independent review—unaffiliated individuals must review the research and approve, amend, or terminate it; (6) informed consent—individuals should be informed about the research and provide their voluntary consent; and (7) respect for enrolled subjects—subjects should have their privacy protected, the opportunity to withdraw, and their well-being monitored. Fulfilling all 7 requirements is necessary and sufficient to make clinical research ethical. These requirements are universal, although they must be adapted to the health, economic, cultural, and technological conditions in which clinical research is conducted.

JAMA. 2000;283:2701-2711

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