MIND-BODY-BEHAVIORAL MED CLINICAL TRIALS INFRASTRUCTURE

描述(由申请人提供)：我们确定了5个障碍，我们认为这些障碍阻碍了心身(行为)医学对普通医学界的影响。这些都是我们的基础设施提案的一个主题，将由4个核心来解决。第一个主题涉及因果机制：许多将压力、认知和情绪与慢性病联系起来的证据都是基于观察性研究。我们建议在干预试验中更好地测试这种机制，并且相同的介体可能参与不同类型的行为干预。相应地，在核心A(机制)中，我们将开发两个测试组，一个评估行为因素(基于认知适应理论)，另一个评估生物因素(基于恒定负荷的概念)，我们将评估它们的因果状态3正在进行的行为临床试验。第二个主题是缺乏心理变量测量的标准化，这将由科雷亚拟议的小组处理，并在核心D(传播)中对其他相关评估领域进行科克伦审查。第三个主题是健康差距和种族问题。大多数慢性病的患病率和不良后果在少数群体中更严重，心理社会因素被认为起着主要作用。然而，许多用于评估这些疾病的工具还没有在这些人群中进行充分的测试。核心B(少数群体健康监督)将解决这些问题。第四个主题是信息技术(核心C)。患者与研究人员或治疗师之间的沟通对任何行为医学努力都是至关重要的，我们建议开发使用平板电脑和手持计算机获取数据的新技术，这应该会提高数据的质量。此外，行为医学是跨学科的，核心c将促进哥伦比亚社区内外调查人员之间的沟通。第五个主题是传播(核心D)-我们认为大多数医生根本不知道行为医学的现有成就，这个核心将执行和传播对行为干预试验和评估工具的Cochrane审查。最终目标是将我们的发现提供给3个目标受众：1)哥伦比亚大学的研究人员网络；2)行为医学社区；3)普通医疗社区。

DESCRIPTION (provided by applicant): We have identified 5 barriers, which we believe have impeded the impact of mind-body (behavioral) medicine on the general medical community. Each of these is a theme of our infrastructure proposal, and will be addressed by 4 Cores. The 1st theme concerns causal mechanisms: much of the evidence relating stress, cognitions, and emotions to chronic disease is based on observational studies. We propose that such mechanisms are better tested within interventional trials, and that the same mediators may be involved in different types of behavioral intervention. Accordingly, in Core A (Mechanisms) we will develop 2 test batteries, one evaluating behavioral factors (based on cognitive adaptation theory), and the other biological factors (based on the concept of allostatic load), and we will assess their causal status 3 ongoing behavioral clinical trials. The 2nd theme is lack of standardization of measures of psychological variables, which will be dealt with by the proposed battery in CoreA, and also a Cochrane review of other relevant assessment areas in Core D (Dissemination). The 3rd theme is health disparities and ethnicity. The prevalence and adverse consequences of most chronic diseases are worse in minority populations, and psychosocial factors are thought to play a major role. However, many of the instruments used to evaluate these have not been adequately tested in these populations. Core B (Minority Health Oversight) will address these issues. The 4th theme is information technology (Core C). Communication between patients and investigators or therapists is critical to any behavioral medicine endeavor, and we propose developing new techniques for data acquisition using tablet and hand-held computers, which should improve the quality of the data. In addition, behavioral medicine is interdisciplinary, and Core c will facilitate communications between investigators both within the Columbia community and outside it. The 5th theme is dissemination (Core D) - we believe that most medical practitioners are simply unaware of the existing achievements of behavioral medicine, and this Core will perform and disseminate Cochrane reviews of behavioral intervention trials and assessment instruments. The ultimate goal will be to make our findings available to 3 target audiences: 1) the network of investigators at Columbia; 2) the behavioral medicine community; and 3) the general medical community.