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.
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 seconds24 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.
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) valueenhancements
of health or knowledge must be derived from the research; (2) scientific validitythe
research must be methodologically rigorous; (3) fair subject selectionscientific
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
ratiowithin 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 reviewunaffiliated individuals must review the
research and approve, amend, or terminate it; (6) informed consentindividuals
should be informed about the research and provide their voluntary consent;
and (7) respect for enrolled subjectssubjects 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
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