BACKGROUND & AIMS: BACKGROUND:Little is known about the impact of the recent varicella vaccine shortage. To assess the temporal trend in varicella vaccine administration before 18 and 24 months of age in a community cohort of children prior to, during and after the recent varicella vaccine shortage. And to compare the temporal trends in varicella vaccinations to trends of an older, more widely accepted vaccine, the MMR. METHODS:Community population-based birth cohorts were identified who were eligible for the varicella vaccination before, during and after the 2001 to 2002 varicella vaccine shortage. Only children (84% of all) who remained in the community through their second birthday were included. For each child in the cohort, the medical records and immunization registry records from both medical facilities in the county were reviewed to identify the dates and sites for all varicella immunizations given. In addition to varicella immunizations, the dates of all MMR vaccinations were recorded. Additional data abstracted included the child's birth date, gender and dates of any recognized cases of chickenpox up through age 24 months. RESULTS:Of the 2,512 children in the birth cohorts, 50.8% were boys. In the three cohorts combined, 81.1% of the boys and 79.3% of the girls (p = 0.30) received the varicella vaccine by age 24 months. The pre-shortage community rate of varicella immunization was 79.7% by 24 months of age. During the varicella vaccine shortage, the rate of varicella immunization by 24 months fell to 77.2%. Only 6 additional children received a "catch-up" immunization by 36 months of age. In the post shortage period the community 24-month immunization rate rebounded to a level higher than the pre-shortage rate 84.0%. During the almost three years of observation, the MMR immunization rate by age 24 months was constant (87%). CONCLUSION:The varicella shortage was associated with an immediate drop in the 24-month varicella immunizations rate but rebounded quickly to above pre-shortage rates. In this community the only long term impact of the varicella vaccine shortage may be on the small number of children who still had not received catch-up varicella immunizations by 36 months of age.

背景与目标： 背景：对最近水痘疫苗短缺的影响知之甚少。在最近的水痘疫苗短缺之前，期间和之后，评估社区队列中儿童在18和24个月大之前接种水痘疫苗的时间趋势。并将水痘疫苗接种的时间趋势与较旧的，被更广泛接受的疫苗MMR的趋势进行比较。
方法：确定2001年至2002年水痘疫苗短缺之前，之中和之后有水痘疫苗接种资格的以社区人群为基础的出生队列。仅包括直到第二个生日仍留在社区中的儿童（占总数的84％）。对于该队列中的每个孩子，都检查了县内两个医疗机构的病历和免疫登记记录，以确定所有水痘疫苗接种的日期和地点。除水痘疫苗接种外，还记录了所有MMR疫苗接种的日期。提取的其他数据包括孩子的出生日期，性别以及直至24个月的任何公认的水痘病例的日期。
结果：在出生队列的2,512名儿童中，男孩占50.8％。在这三个队列中，到24个月大时，有81.1％的男孩和79.3％的女孩（p = 0.30）接受了水痘疫苗。到24个月大时，水痘疫苗的短缺前社区接种率为79.7％。在水痘疫苗短缺期间，水痘疫苗的免疫率在24个月内下降到77.2％。到36个月大时，仅再有6名儿童接受了“追赶”免疫。在短缺后时期，社区24个月的免疫接种率反弹到高于短缺前84.0％的水平。在将近三年的观察中，到24个月大时的MMR免疫率是恒定的（87％）。
结论：水痘短缺与24个月水痘疫苗接种率立即下降有关，但迅速反弹至短缺前水平。在这个社区中，水痘疫苗短缺的唯一长期影响可能是对仍在36个月大时仍未接受追赶水痘免疫接种的少数儿童。

BACKGROUND & AIMS: OBJECTIVE:To identify reasons why rural general practitioners (GPs) treat a large proportion of patients with a primary psychiatric diagnosis in general beds of their local hospitals, and the barriers encountered when providing this treatment. DESIGN:A postal questionnaire was developed and distributed to a sample of rural GPs, asking about the treatment of patients with an acute mental illness in their local hospital. RESULTS:The majority of GPs agreed that they treat the acutely mentally ill in general beds of their local hospital due to lack of availability of, and inability to gain access to, mental health beds in the larger centres; and also to enable ongoing family involvement and continuity of care. Distance factors were identified as least significant. Barriers to providing care to this group of patients included a perceived lack of support by consultant psychiatrists, confidentiality issues, lack of community mental health workers to provide assistance, aggression levels of patients, inappropriate local hospital setting, and lack of confidence of GPs and general hospital nursing staff. CONCLUSION:Addressing these barriers is necessary if rural Australians are to receive a quality of care that is equal to that received by those located in metropolitan Australia. Continuing research in this area is crucial.

背景与目标： 目的：查明农村全科医生（GPs）在其当地医院的普通病床中治疗大部分患有原发性精神病诊断的患者的原因，以及提供这种治疗时遇到的障碍。
设计：开发了一份邮政调查表，并将其分发给农村全科医生的样本，询问在当地医院治疗患有急性精神疾病的患者的情况。
结果：大多数全科医生都同意，由于在较大的中心缺乏精神病床，并且无法获得精神病床，他们在当地医院的普通病床中治疗严重的精神疾病；并使家庭不断参与并获得连续护理。距离因素被确定为最不重要的。向此类患者提供护理的障碍包括：咨询精神病医生缺乏支持，机密性问题，缺乏社区精神卫生工作者提供援助，患者的攻击性，当地医院的环境不适当以及全科医生和普通医生的信心不足医院护理人员。
结论：如果要使澳大利亚农村人口获得与澳大利亚大都市居民相同的医疗质量，则必须解决这些障碍。在这一领域的持续研究至关重要。

BACKGROUND & AIMS: :In the present pilot study, the feasibility of a site-of-care cervicovaginal self-sampling methodology for HPV-based screening was tested in 346 women residing in underserved rural areas of Northern Greece. These women provided self-collected cervicovaginal sample along with a study questionnaire. Following molecular testing, using the cobas® HPV Test, Roche®, HPV positive women, were referred to colposcopy and upon abnormal findings, to biopsy and treatment. Participation rate was 100%. Regular pap-test examination was reported for 17.1%. Among hrHPV testing, 11.9% were positive and colposcopy/biopsy revealed 2 CIN3 cases. Non-compliance was the most prevalent reason for no previous attendance. Most women reported non-difficulty and non-discomfort in self-sampling (77.6% and 82.4%, respectively). They would choose self-sampling over clinician-sampling (86.2%), and should self-sampling being available, they would test themselves more regularly (92.3%). In conclusion, self-sampling is feasible and well-accepted for HPV-based screening, and could increase population coverage in underserved areas, helping towards successful prevention.

背景与目标： ：在本项初步研究中，对希腊北部农村地区服务水平低下的346名妇女进行了基于宫颈癌阴道自我采样方法的HPV筛查的可行性的测试。这些妇女提供了自己收集的宫颈阴道样本以及研究问卷。在进行分子测试后，使用cobas®HPV测试，将Roche®，HPV阳性女性进行阴道镜检查，并在发现异常后进行活检和治疗。参与率为100％。定期进行巴氏试验检查的报道为17.1％。在hrHPV测试中，有11.9％呈阳性，阴道镜检查/活检显示有2例CIN3病例。不遵守是没有参加会议的最普遍原因。大多数妇女在自我抽样中报告没有困难和不舒服（分别为77.6％和82.4％）。他们将选择自采样而不是临床医生采样（86.2％），并且如果可以使用自采样，他们将更定期地进行自我测试（92.3％）。总之，对于基于HPV的筛查，自我抽样是可行的并且被广泛接受，并且可以扩大服务不足地区的人口覆盖率，有助于成功进行预防。

BACKGROUND & AIMS: INTRODUCTION:Fatigue after treatment for breast cancer (BC) is common, but poorly understood. We examined the fatigue levels during first year after radiotherapy (RT) according to the extent of RT (local or locoregional), hormonal therapy (HT) and chemotherapy (CT). The impact of comorbidity was also explored. Moreover, we compared fatigue levels in patients with the general population (GenPop) data. MATERIAL AND METHODS:BC patients (n = 250) referred for post-operative RT at St. Olavs Hospital, Trondheim, Norway, were enrolled. Fatigue was measured by the EORTC QLQ-C30-fatigue subscale, ranging from 0 to 100, before RT (baseline), after RT, and at three, six, and 12 months. Clinical and treatment-related factors were recorded at baseline. GenPop data was available from a previous survey (n = 652). Linear mixed models and analysis of covariance were applied. RESULTS:Compliance ranged from 87% to 98%. At baseline, mean value (SD) of fatigue in BC patients was 26.8 (23.4). The level increased during RT (mean change 8.3, 95% CI 5.5-11.1), but declined thereafter and did not differ significantly from pre-treatment levels at subsequent time points. In age-adjusted analyses, locoregional RT accounted for more overall fatigue than local RT (mean difference 6.6, 95% CI 1.2-12.0), but the association was weakened and not statistical significant when adjusting for CT and HT. Similar pattern was seen for CT and HT. The course of fatigue differed significantly by CT (p < 0.001, interaction test). At baseline, fatigue levels were higher in patients with than without CT, but at subsequent time points similar levels were evident, indicating a temporary adverse effect of CT. Comorbidity was significantly associated with increased level of fatigue, independent of other factors (mean difference 8.1, 95% CI 2.2-14.1). BC-patients were not significantly more fatigued than GenPop, except for immediately after ending RT, and then only among those without comorbidity (mean 35.9 vs. 25.8, p < 0.001). CONCLUSION:Comorbidity seems to be a more important determinant for fatigue levels than the cancer treatment.

背景与目标： 简介：乳腺癌（BC）治疗后的疲劳很普遍，但了解甚少。我们根据放疗（局部或局部），激素治疗（HT）和化学疗法（CT）的程度，检查了放疗（RT）后第一年的疲劳水平。还探讨了合并症的影响。此外，我们将一般人群（GenPop）数据的患者的疲劳水平进行了比较。
材料与方法：招募了在挪威特隆赫姆的圣奥拉夫斯医院接受手术后放疗的BC患者（n = 250）。疲劳通过EORTC QLQ-C30疲劳分量表进行测量，范围为0至100，RT前（基线），RT后以及3、6和12个月。在基线记录临床和治疗相关因素。 GenPop数据可从以前的调查中获得（n = 652）。应用线性混合模型和协方差分析。
结果：依从性从87％到98％不等。基线时，BC患者的疲劳平均值（SD）为26.8（23.4）。在放疗期间该水平升高（平均变化8.3，95％CI 5.5-11.1），但此后下降，并且在随后的时间点与治疗前水平无显着差异。在年龄校正的分析中，局部RT比局部RT引起的整体疲劳更多（平均差异6.6，95％CI 1.2-12.0），但在校正CT和HT时，关联性减弱并且没有统计学意义。 CT和HT观察到相似的模式。 CT的疲劳过程明显不同（p <0.001，相互作用测试）。在基线时，有CT的患者的疲劳水平高于没有CT的患者，但是在随后的时间点，相似的水平也很明显，表明CT的暂时不良反应。与其他因素无关，合并症与疲劳程度增加显着相关（平均差异8.1，95％CI 2.2-14.1）。 BC患者没有比GenPop明显疲劳，除了RT结束后立即缓解，然后才出现在没有合并症的患者中（平均35.9 vs. 25.8，p <0.001）。
结论：合并症似乎是比癌症治疗更为重要的疲劳程度决定因素。

BACKGROUND & AIMS: :The cause-effect relationship between iron deficiency anemia (IDA) and osteoporosis has not been established in the general population. Thus, the current longitudinal study determined the role of IDA as a risk factor for osteoporosis by analyzing a large nationwide population-based sample. In a sample of 1,000,000 randomly sampled individuals from the 1998-2012. Taiwan National Health Insurance Research Database, patients with IDA (case group (n = 35,751)) and individuals without IDA (control group (n = 178,755)) were compared. Patients who were <20 years of age and who had pre-existing osteoporosis prior to the diagnosis of IDA were excluded. Each patient with IDA was age- and gender-matched to five individuals without IDA. The diagnoses of IDA and osteoporosis (coded using ICD-9CM) were further confirmed with blood test results and X-ray bone densitometry to ensure the accuracy of the diagnoses. Osteoporosis occurred more often among patients with IDA compared to individuals without IDA (2.27% vs. 1.32%, p < 0.001). Cox proportional hazard analysis revealed that the risk for osteoporosis was significantly higher in the case than the control group (hazard ratio (HR) = 1.74; 95% CI = 1.61-1.88) and remained similar after adjustment for covariates (adjusted HR = 1.81; 95% CI = 1.67-1.97). Compared with individuals without IDA, the risk for osteoporosis was even higher for patients with IDA who received intravenous ferrum therapy (adjusted HR = 2.21; 95% CI = 1.85-2.63). In contrast, the risk for osteoporosis was reduced for patients with IDA who received a blood transfusion (adjusted HR = 1.47; 95% CI = 1.20-1.80). As a predictor, prior IDA is a significant and independent risk factor for development of osteoporosis.

背景与目标： ：铁缺乏性贫血（IDA）和骨质疏松症之间的因果关系尚未建立。因此，当前的纵向研究通过分析全国范围内大量的基于人群的样本，确定了IDA作为骨质疏松症危险因素的作用。在1998年至2012年的1,000,000个随机样本中进行抽样。台湾国家健康保险研究数据库比较了IDA患者（病例组（n = 35,751））和无IDA患者（对照组（n = 178,755））。年龄小于20岁且在IDA诊断之前已存在骨质疏松症的患者被排除在外。每名IDA患者的年龄和性别均与5名没有IDA的患者相匹配。通过血液测试结果和X射线骨密度测定进一步证实了IDA和骨质疏松的诊断（使用ICD-9CM编码），以确保诊断的准确性。与没有IDA的患者相比，IDA患者的骨质疏松症发生率更高（2.27％对1.32％，p <0.001）。 Cox比例风险分析显示，骨质疏松症的风险明显高于对照组（风险比（HR）= 1.74； 95％CI = 1.61-1.88），并且在调整协变量后（调整后HR = 1.81； 95％CI = 1.67-1.97）。与没有IDA的个体相比，接受静脉铁素治疗的IDA患骨质疏松症的风险更高（校正后的HR = 2.21； 95％CI = 1.85-2.63）。相反，接受输血的IDA患者的骨质疏松风险降低（校正后的HR = 1.47； 95％CI = 1.20-1.80）。作为预测因素，先前的IDA是骨质疏松症发展的重要且独立的危险因素。

BACKGROUND & AIMS: BACKGROUND AND OBJECTIVES:Olaratumab is a recombinant human monoclonal antibody that binds to platelet-derived growth factor receptor-α (PDGFRα). In a randomized phase II study, olaratumab plus doxorubicin met its predefined primary endpoint for progression-free survival and achieved a highly significant improvement in overall survival versus doxorubicin alone in patients with advanced or metastatic soft tissue sarcoma (STS). In this study, we characterize the pharmacokinetics (PKs) of olaratumab in a cancer patient population. METHODS:Olaratumab was tested at 15 or 20 mg/kg in four phase II studies (in patients with nonsmall cell lung cancer, glioblastoma multiforme, STS, and gastrointestinal stromal tumors) as a single agent or in combination with chemotherapy. PK sampling was performed to measure olaratumab serum levels. PK data were analyzed by nonlinear mixed-effect modeling techniques using NONMEM®. RESULTS:The PKs of olaratumab were best described by a two-compartment PK model with linear clearance (CL). Patient body weight was found to have a significant effect on both CL and central volume of distribution (V 1), whereas tumor size significantly affected CL. A small subset of patients developed treatment-emergent anti-drug antibodies (TE-ADAs); however, TE-ADAs did not have any effect on CL or PK time course of olaratumab. There was no difference in the PKs of olaratumab between patients who received olaratumab as a single agent or in combination with chemotherapy. CONCLUSION:The PKs of olaratumab were best described by a model with linear disposition. Patient body weight and tumor size were found to be significant covariates. The PKs of olaratumab were not affected by immunogenicity or chemotherapeutic agents.

背景与目标： 背景与目的：Olaratumab是一种重组人单克隆抗体，可与血小板衍生的生长因子受体-α（PDGFRα）结合。在一项随机的II期研究中，奥拉单抗加阿霉素达到了无进展生存的预定主要终点，与晚期或转移性软组织肉瘤（STS）患者相比，阿霉素的总生存率有了显着提高。在这项研究中，我们表征了olaratumab在癌症患者人群中的药代动力学（PKs）。
方法：奥拉单抗在四项II期研究（非小细胞肺癌，多形性胶质母细胞瘤，STS和胃肠道间质瘤患者）中以15或20 mg / kg的浓度进行了单药或联合化疗的测试。进行PK采样以测量olaratumab血清水平。使用NONMEM®通过非线性混合效应建模技术分析PK数据。
结果：用具有线性清除率（CL）的两室PK模型可以最好地描述olaratumab的PK。发现患者体重对CL和中心分布体积（V 1）均具有显着影响，而肿瘤大小显着影响CL。一小部分患者发展了治疗性抗药物抗体（TE-ADAs）；但是，TE-ADAs对olaratumab的CL或PK时间进程没有任何影响。在单药或联合化疗的情况下，接受olaratumab治疗的患者中olaratumab的PKs没有差异。
结论：用线性处置模型可以最好地描述olaratumab的PKs。发现患者体重和肿瘤大小是显着的协变量。 Olaratumab的PKs不受免疫原性或化学治疗剂的影响。

BACKGROUND & AIMS: BACKGROUND:In the first population-based study of psychopathology conducted in Haiti, we documented earthquake-related experiences associated with risk for posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) 2-4 months following the 2010 Haiti earthquake. METHODS:A population-based survey was conducted of 1,323 survivors randomly selected from the general nondisplaced community, internally displaced persons camps, and a community clinic. Respondents were from the Nazon area of Port-au-Prince, ∼20 miles from the epicenter. RESULTS:Respondents (90.5%) reported at least one relative/close friend injured/killed, 93% saw dead bodies, and 20.9% lost their job post-earthquake. The prevalence of PTSD (24.6%) and MDD (28.3%) was high. History of violent trauma was associated with risk of PTSD and MDD (adjusted odds ratio [AOR] 1.4, 95% confidence interval [CI], 1.0-1.9; AOR, 1.7, 95% CI 1.3, 2.2, respectively). Low social support (AOR, 1.7, 95% CI 1.2, 2.3; AOR 1.4, 95% CI 1.0, 1.9, respectively) increased risk of PTSD and MDD among women. Suffering damage to the home increased risk of MDD in males (AOR 2.8, 95% CI 1.5, 5.5). Associations between being trapped in rubble, major damage to house, job loss, and PTSD; and participation in rescue/recovery, friends/family injured/killed, and MDD varied based on prior history of violent trauma. CONCLUSIONS:Addressing mental health in a post-earthquake setting such as Haiti will require focusing resources on screening and treatment of identified vulnerable groups while targeting improvement of post-earthquake living conditions. Investment in sources of social support for women may make help mitigate the vulnerability of women to PTSD and MDD.

背景与目标： 背景：在海地进行的第一项基于人群的心理病理学研究中，我们记录了与地震相关的经历，这些经历与2010年海地地震发生后2-4个月的创伤后应激障碍（PTSD）和重度抑郁症（MDD）风险相关。
方法：基于人口的调查是对从普通非流离失所社区，国内流离失所者营地和社区诊所中随机选择的1,323名幸存者进行的。受访者来自太子港的纳松地区，距震中约20英里。
结果：受访者（90.5％）报告说，至少有一个亲戚/密友受伤/被杀，93％的人有尸体，20.9％的人在地震后丧生。 PTSD（24.6％）和MDD（28.3％）的患病率很高。暴力创伤史与PTSD和MDD的风险有关（校正比值比[AOR]为1.4，95％置信区间[CI]为1.0-1.9； AOR为1.7、95％CI为1.3、2.2）。较低的社会支持（分别为AOR，1.7、95％CI 1.2、2.3，AOR 1.4、95％CI 1.0、1.9）增加了妇女罹患PTSD和MDD的风险。房屋遭受损坏会增加男性罹患MDD的风险（AOR 2.8，95％CI 1.5，5.5）。被困在瓦砾中，对房屋的重大破坏，失业和PTSD之间的关联；根据先前的暴力创伤史，参与救援/恢复，朋友/家人受伤/被打死以及MDD的情况也有所不同。
结论：在诸如海地这样的地震后环境中解决心理健康问题，将需要把资源集中在筛查和治疗已确定的弱势群体上，同时着眼于改善地震后的生活条件。对妇女的社会支持来源的投资可能有助于减轻妇女对PTSD和MDD的脆弱性。

BACKGROUND & AIMS: PURPOSE:Descriptive studies have indicated a rising trend in Hodgkin's lymphoma (HL) incidence in young adults, especially females. Increasing evidence has suggested that some risk factors associated with HL may vary by age or gender. Recent studies have reported an increased risk of HL associated with increasing body mass index (BMI), but the results have been inconsistent. The objectives of this study were to examine whether the associations between measures of body size (height, weight, and BMI) and HL risk vary by age and/or gender. METHODS:A population-based case-control study was conducted in Connecticut and Massachusetts. A total of 567 HL cases and 679 controls were recruited in 1997-2000. Unconditional logistic regression was used to calculate odds ratios (ORs) and 95 % confidence intervals (CIs). RESULTS:Among younger women <35 years old, being overweight (25-29.9 kg/m(2)) versus normal weight (18.5-24.9 kg/m(2)) was significantly associated with an increased risk of HL (OR = 2.1, 95 % CI = 1.1-4.0). The risk increased with increasing weight and BMI (p trends <0.01). Among women ≥35 years old, by contrast, higher weight and BMI were associated with a reduced risk of HL (p trends <0.01). Conversely, there was no significant association between BMI and risk of HL in younger or older males. CONCLUSIONS:These findings show that the associations between body size and risk of HL vary by gender and age, and require confirmation in other populations.

背景与目标： 目的：描述性研究表明，霍奇金淋巴瘤（HL）的发病率在年轻人中，尤其是女性中呈上升趋势。越来越多的证据表明，与HL相关的某些危险因素可能随年龄或性别而变化。最近的研究报告了与体重指数（BMI）增加相关的HL风险增加，但结果不一致。这项研究的目的是检查身体大小（身高，体重和BMI）与HL风险之间的关系是否随年龄和/或性别而变化。
方法：在康涅狄格州和马萨诸塞州进行了一项基于人群的病例对照研究。在1997-2000年间，共招募了567例HL病例和679例对照。使用无条件逻辑回归来计算比值比（OR）和95％置信区间（CIs）。
结果：<35岁的年轻女性中，超重（25-29.9 kg / m（2））与正常体重（18.5-24.9 kg / m（2））与HL风险增加显着相关（OR = 2.1 ，95％CI = 1.1-4.0）。风险随着体重和BMI的增加而增加（p趋势<0.01）。相比之下，≥35岁的女性中，体重增加和BMI升高与HL风险降低相关（p趋势<0.01）。相反，年轻或老年男性的BMI与HL风险之间没有显着相关性。
结论：这些发现表明，体型与HL风险之间的关联因性别和年龄而异，需要在其他人群中进行确认。

BACKGROUND & AIMS: BACKGROUND:Laparoscopic gastric bypass surgery (LGBS) has become the most widely used bariatric procedure due to its beneficial long-term outcomes for patients with morbid obesity. However, it is unclear whether racial differences in admission for LGBS have changed over time compared to racial differences in all other admissions. We aimed to investigate the trends and differences in the use of LGBS among white, African-American, and Hispanic patients from 2002 to 2008. METHODS:We performed a secondary analysis of data on obese adult patients operated between 2002 and 2008, using the Nationwide Inpatient Sample (NIS) database. The probability of being admitted for LGBS was estimated using logistic regression with race, year, and year by race interaction as predictors, controlling for numerous patient and hospital characteristics. RESULTS:Among 1,704,972 obese hospitalized patients captured through NIS from 2002 to 2008, 2.6 % underwent LGBS (2.8 % Whites, 1.7 % African-Americans, and 2.6 % Hispanics). In adjusted analysis, obese African-American (OR 0.48, p < 0.001) and Hispanic patients (OR 0.59, p < 0.001) were less likely to be admitted for LGBS than white patients in 2002. Race-year interactions showed that the odds of African-Americans undergoing LGBS significantly increased from 2002 to 2008 compared with Whites (annual OR 1.03, p < 0.001) while no such increase was detected for Hispanics (annual OR 1.02, p = 0.11). In 2008, African-American (OR 0.58, p < 0.001) and Hispanic patients (OR 0.65, p < 0.001) still had lower odds than white patients. CONCLUSIONS:This is the first study showing that the difference in the use of LGBS between obese African-American and white patients declined between 2002 and 2008. However, LGBS use still remained significantly lower for both African-American and Hispanic patients in 2008 compared with white patients.

背景与目标： 背景：腹腔镜胃旁路手术（LGBS）由于对病态肥胖患者有益的长期疗效，已成为减肥手术中使用最广泛的方法。但是，目前尚不清楚与所有其他录取中的种族差异相比，LGBS录取中的种族差异是否随时间变化。我们旨在调查2002年至2008年间白人，非裔美国人和西班牙裔患者使用LGBS的趋势和差异。
方法：我们使用全国住院患者样本（NIS）数据库对2002年至2008年间肥胖成人患者的数据进行了二次分析。使用种族，年份和年份（通过种族相互作用作为预测因素）进行逻辑回归，以控制众多患者和医院的特征为基础，估算了被纳入LGBS的可能性。
结果：从2002年到2008年，通过NIS捕获的1,704,972例肥胖住院患者中，有2.6％接受了LGBS治疗（2.8％的白人，1.7％的非裔美国人和2.6％的西班牙裔）。在校正后的分析中，2002年，肥胖的非洲裔美国人（OR 0.48，p <0.001）和西班牙裔患者（OR 0.59，p <0.001）与白人患者相比，LGBS入院的可能性较小。与白人相比，经历LGBS的非裔美国人在2002年至2008年间显着增加（年度OR 1.03，p <0.001），而西班牙裔未发现此类增加（年度OR 1.02，p = 0.11）。 2008年，非裔美国人（OR 0.58，p <0.001）和西班牙裔患者（OR 0.65，p <0.001）的患病几率仍低于白人患者。
结论：这是第一项研究，表明肥胖的非洲裔美国人和白人患者使用LGBS的差异在2002年至2008年之间有所下降。但是，与2008年相比，非洲裔美国人和西班牙裔患者的LGBS使用率仍然明显低于2008年。白人患者。

BACKGROUND & AIMS: :Adaptive radiations are an important source of biodiversity and are often characterized by many speciation events in very short succession. It has been proposed that the high speciation rates in these radiations may be fuelled by novel genetic combinations produced in episodes of hybridization among the young species. The role of such hybridization events in the evolutionary history of a group can be investigated by comparing the genealogical relationships inferred from different subsets of loci, but such studies have thus far often been hampered by shallow genetic divergences, especially in young adaptive radiations, and the lack of genome-scale molecular data. Here, we use a genome-wide sampling of SNPs identified within restriction site-associated DNA (RAD) tags to investigate the genomic consistency of patterns of shared ancestry and adaptive divergence among five sympatric cichlid species of two genera, Pundamilia and Mbipia, which form part of the massive adaptive radiation of cichlids in the East African Lake Victoria. Species pairs differ along several axes: male nuptial colouration, feeding ecology, depth distribution, as well as the morphological traits that distinguish the two genera and more subtle morphological differences. Using outlier scan approaches, we identify signals of divergent selection between all species pairs with a number of loci showing parallel patterns in replicated contrasts either between genera or between male colour types. We then create SNP subsets that we expect to be characterized to different extents by selection history and neutral processes and describe phylogenetic and population genetic patterns across these subsets. These analyses reveal very different evolutionary histories for different regions of the genome. To explain these results, we propose at least two intergeneric hybridization events (between Mbipia spp. and Pundamilia spp.) in the evolutionary history of these five species that would have lead to the evolution of novel trait combinations and new species.

背景与目标： ：适应性辐射是生物多样性的重要来源，并且通常以非常短的连续时间内的许多物种形成事件为特征。已经提出，这些辐射中的高物种形成率可能是由年轻物种之间的杂交事件中产生的新型遗传组合所推动的。可以通过比较从基因座的不同子集推断出的家谱关系来研究此类杂交事件在一组进化史中的作用，但迄今为止，此类研究通常受到浅层遗传差异（尤其是在年轻的适应性辐射中）的阻碍。缺乏基因组规模的分子数据。在这里，我们使用在限制性位点相关的DNA（RAD）标记内确定的SNP的全基因组采样来调查两个谱系（Pundamilia和Mbipia）的五个同胞慈鲷科动物的共有祖先和适应性分歧模式的基因组一致性东非维多利亚湖中丽鱼科鱼大规模适应性辐射的一部分。物种对在几个轴上有所不同：雄性婚礼的着色，进食生态，深度分布以及区分两个属和更细微形态差异的形态特征。使用离群扫描方法，我们确定了所有物种对之间的差异选择信号，其中多个基因座在属间或雄性颜色类型之间的复制对比中显示出平行模式。然后，我们创建SNP子集，我们希望这些子集可以通过选择历史和中性过程在不同程度上进行表征，并描述这些子集的系统发育和种群遗传模式。这些分析揭示了基因组不同区域的非常不同的进化历史。为了解释这些结果，我们提出了这五个物种的进化史中至少两个属间杂交事件（Mbipia spp。和Pundamilia spp。之间），这将导致新性状组合和新物种的进化。

BACKGROUND & AIMS: OBJECTIVES:In a large population-based study among adults in northern Europe the relation between occupational exposure and new-onset asthma was studied. METHODS:The study comprised 13 284 subjects born between 1945 and 1973, who answered a questionnaire 1989-1992 and again 1999-2001. Asthma was defined as 'Asthma diagnosed by a physician' with reported year of diagnose. Hazard ratios (HR), for new-onset adult asthma during 1980-2000, were calculated using a modified job-exposure matrix as well as high-risk occupations in Cox regression models. The analyses were made separately for men and women and were also stratified for atopy. RESULTS:During the observation period there were 429 subjects with new-onset asthma with an asthma incidence of 1.3 cases per 1000 person-years for men and 2.4 for women. A significant increase in new-onset asthma was seen for men exposed to plant-associated antigens (HR = 3.6; 95% CI [confidence interval] = 1.4-9.0), epoxy (HR = 2.4; 95% CI = 1.3-4.5), diisocyanates (HR = 2.1; 95% CI = 1.2-3.7) and accidental peak exposures to irritants (HR = 2.4; 95% CI = 1.3-4.7). Both men and women exposed to cleaning agents had an increased asthma risk. When stratifying for atopy an increased asthma risk were seen in non-atopic men exposed to acrylates (HR = 3.3; 95% CI = 1.4-7.5), epoxy compounds (HR = 3.6; 95% CI = 1.6-7.9), diisocyanates and accidental peak exposures to irritants (HR = 3.0; 95% CI = 1.2-7.2). Population attributable risk for occupational asthma was 14% for men and 7% for women. CONCLUSIONS:This population-based study showed that men exposed to epoxy, diisocyanates and acrylates had an increased risk of new-onset asthma. Non-atopics seemed to be at higher risk than atopics, except for exposure to high molecular weight agents. Increased asthma risks among cleaners, spray painters, plumbers, and hairdressers were confirmed.

背景与目标： 目的：在北欧一项基于人群的大型研究中，研究了职业暴露与新发哮喘之间的关系。
方法：该研究包括13 284名出生于1945年至1973年之间的受试者，他们分别回答了1989-1992年和1999-2001年的问卷。哮喘被定义为“具有医生诊断的哮喘”，并报告了诊断年份。使用修正的工作暴露矩阵以及Cox回归模型中的高风险职业，计算1980-2000年期间新发成人哮喘的危险比（HR）。分别对男性和女性进行了分析，并对特应性进行了分层。
结果：在观察期内，有429例新发哮喘患者，男性每1000人年1.3例，女性2.4例。暴露于植物相关抗原（HR = 3.6； 95％CI [置信区间] = 1.4-9.0），环氧（HR = 2.4； 95％CI = 1.3-4.5）的男性新发哮喘显着增加。 ，二异氰酸酯（HR = 2.1； 95％CI = 1.2-3.7）和意外峰值暴露于刺激物（HR = 2.4； 95％CI = 1.3-4.7）。男性和女性都接触清洁剂会增加患哮喘的风险。当进行特应性分层时，在暴露于丙烯酸酯（HR = 3.3； 95％CI = 1.4-7.5），环氧化合物（HR = 3.6； 95％CI = 1.6-7.9），二异氰酸酯和意外峰值暴露于刺激物（HR = 3.0； 95％CI = 1.2-7.2）。职业性哮喘的人群归因风险是男性为14％，女性为7％。
结论：这项基于人群的研究表明，暴露于环氧，二异氰酸酯和丙烯酸酯的男性罹患新发哮喘的风险增加。除了暴露于高分子量药物外，非异位症的风险似乎高于异位症。确认清洁工，喷漆工，水管工和美发师中哮喘风险增加。

BACKGROUND & AIMS: BACKGROUND:in men, the concomitant use of two or more benzodiazepines or two or more antipsychotics is associated with an increased risk of fracture(s). Potential associations between the concomitant use of drugs with central nervous system effects and fracture risk have not been studied. OBJECTIVE:the purpose was to describe the gender-specific risk of fractures in a population aged 65 years or over associated with the use of an opioid, antiepileptic or anticholinergic drug individually; or, their concomitant use with each other; or the concomitant use of one of these with a psychotropic drug. METHODS:this study was part of a prospective, population-based study performed in Lieto, Finland. Information about fractures in 1,177 subjects (482 men and 695 women) was confirmed with radiology reports. RESULTS:at 3 years of follow-up, the concomitant use of an opioid with an antipsychotic was associated with an increased risk of fractures in men. During the 6-year follow-up, the concomitant use of an opioid with a benzodiazepine was also related to the risk of fractures for males. No significant associations were found for females. CONCLUSION:the concomitant use of an opioid with an antipsychotic, or with a benzodiazepine may increase the risk of fractures in men aged 65 years and older.

背景与目标： 背景：在男性中，同时使用两种或多种苯二氮杂类或两种或多种抗精神病药会增加骨折的风险。尚未研究同时使用药物与中枢神经系统作用与骨折风险之间的潜在关联。
目的：目的是描述在65岁或65岁以上人群中因单独使用阿片类药物，抗癫痫药或抗胆碱能药物引起的骨折的性别特异性风险；或同时使用；或或将其中一种与精神药物同时使用。
方法：本研究是在芬兰利托进行的一项基于人群的前瞻性研究的一部分。放射学报告证实了有关1,177名受试者（482名男性和695名女性）骨折的信息。
结果：在随访的3年中，同时使用阿片类药物和抗精神病药会增加男性骨折的风险。在6年的随访期间，阿片类药物与苯二氮卓类药物同时使用也与男性骨折风险有关。没有发现与女性的显着关联。
结论：阿片类药物与抗精神病药或苯二氮卓类药物同时使用可能会增加65岁以上男性骨折的风险。

BACKGROUND & AIMS: OBJECTIVE:To obtain prevalence estimates of clinical features of obstructive sleep apnoea (OSA) and identify the dimensions of the public health problem requiring further investigation for an Australian population. METHODS:The South Australian Health Omnibus Survey is an annual representative population survey of South Australians aged≥15 years, conducted via interviewer-administered questionnaire. In 2009, 3007 participants were asked the STOP-BANG instrument measure of obstructive sleep apnoea risk, which includes symptoms of loud snoring, frequent tiredness during daytime, observed apnoea, and high blood pressure (STOP), and measured body mass index, age, neck circumference and gender (BANG). Three or more positive response categorises a person at high risk for OSA. RESULTS:Snoring was reported by 49.7% of adults. Tiredness after sleep more than 3 - 4 times per week was reported by 24.8%, and during wake-time by 27.7% of adults, with 8.8% reporting having fallen asleep while driving. Over half of the surveyed men (57.1%, n=566) and 19.3% (n=269) of the women were classified at high-risk of OSA with the STOP-BANG measure. In multivariable models, high risk was associated with less education, lower income, and residence in a regional rather than metropolitan area. CONCLUSION:The high prevalence of adults at risk for OSA suggests that the capacity currently available within the healthcare system to investigate and diagnose OSA is likely to be inadequate, particularly outside urban areas. This highlights an important public health problem that requires further detailed study and trials of new models of care.

背景与目标： 目的：获得阻塞性睡眠呼吸暂停（OSA）临床特征的患病率估计值，并确定需要进一步调查的澳大利亚人群公共卫生问题的范围。
方法：《南澳大利亚健康综合调查》是对年满15岁的南澳大利亚人进行的年度代表性人口调查，通过访调员管理的问卷调查进行。 2009年，有3007名参与者被要求使用STOP-BANG仪器测量阻塞性睡眠呼吸暂停的风险，包括大声打，白天频繁疲倦，观察到的呼吸暂停和高血压（STOP）的症状，以及测得的体重指数，年龄，脖子围和性别（BANG）。三个或更多的积极反应将高OSA风险的人归类。
结果：49.7％的成年人打S。据报告，睡眠后每周疲倦超过3-4次，占24.8％；在唤醒时间，成年人中有27.7％，其中有8.8％的人在开车时睡着了。通过STOP-BANG措施将超过一半的男性（57.1％，n = 566）和19.3％（n = 269）的女性归为OSA高危人群。在多变量模型中，高风险与受教育程度较低，收入较低以及居住在区域而不是大都市地区有关。
结论：高危人群中存在OSA的高患病率表明，医疗系统中目前可用于调查和诊断OSA的能力可能不足，尤其是在城市地区以外。这突出了一个重要的公共卫生问题，需要对新的护理模式进行进一步的详细研究和试验。

BACKGROUND & AIMS: :Over the course of its long history, Armenia has acted as both a source of numerous indigenous cultures and as a recipient of foreign invasions. As a result of this complex history among populations, the gene pool of the Armenian population may contain traces of historically well-documented ancient migrations. Furthermore, the regions within the historical boundaries of Armenia possess unique demographic histories, having hosted both autochthonous and specific exogenous genetic influences. In the present study, we analyze the Armenian population sub-structure utilizing 17 Y-chromosome short tandem repeat (Y-STR) loci of 412 Armenians from four geographically and anthropologically well-defined groups (Ararat Valley, Gardman, Lake Van and Sasun). To place the genetic composition of Armenia in a regional and historic context, we have compared the Y-STR profiles from these four Armenian collections to 18 current-day Eurasian populations and two ancient DNA collections. Our results illustrate regional trends in Armenian paternal lineages and locale-specific patterns of affinities with neighboring regions. Additionally, we observe a phylogenetic relationship between the Northern Caucasus and the group from Sasun, which offers an explanation for the genetic divergence of this group from other three Armenian collections. These findings highlight the importance of analyzing both general populations as well as geographically defined sub-populations when utilizing Y-STRs for forensic analyses and population genetics studies.

背景与目标： ：在悠久的历史过程中，亚美尼亚既是众多土著文化的发源地，又是外国入侵的接受者。由于人口之间的这种复杂的历史，亚美尼亚人口的基因库可能包含历史上有据可查的古代移民的痕迹。此外，亚美尼亚历史范围内的地区拥有独特的人口历史，既受到了本地遗传的影响，也受到了特定的外源遗传的影响。在本研究中，我们使用来自四个地理和人类学上明确定义的群体（阿拉拉特山谷，加德曼，范湖和萨桑）的412个亚美尼亚人的17个Y染色体短串联重复序列（Y-STR）位点来分析亚美尼亚人口的子结构。 。为了将亚美尼亚的遗传组成放在区域和历史背景下，我们比较了这四个亚美尼亚收藏与18个现今欧亚人口和两个古代DNA收藏的Y-STR图谱。我们的结果说明了亚美尼亚父系血统的区域趋势以及与邻近区域的亲和力的特定于区域的模式。此外，我们观察到北高加索地区与萨桑（Sasun）地区的群体之间存在系统发育关系，这为该群体与其他三个亚美尼亚物种的遗传差异提供了解释。这些发现凸显了在使用Y-STRs进行法医分析和人口遗传学研究时，分析一般人群以及地理上定义的亚群的重要性。

BACKGROUND & AIMS: OBJECTIVE:The epidemic of obesity and type 2 diabetes is evident in sub-Saharan Africa (SSA). However, their associations have hardly been examined in this region. METHODS:A hospital-based case-control study in urban Ghana consisting of 1221 adults (542 cases and 679 controls) investigated the role of anthropometric parameters for diabetes. Logistic regression was used for analysis. The discriminative power and population-specific cut-off points for diabetes were identified by receiver operating characteristic curves. RESULTS:The strongest association with diabetes was observed for waist-to-hip ratio: age-adjusted odds ratios per 1 standard deviation difference were 1.95 (95% confidence interval [CI]: 1.64-2.31) in women and 1.40 [1.01-1.94] in men. Also, among women, the odds of diabetes increased with higher waist circumference (1.35 [1.17-1.57]) and waist-to-height ratio (1.29 [1.12-1.50]). Among men, this was not discernible. Rather, hip circumference was inversely related (0.69 [0.50-0.95]). Body mass index was neither associated with diabetes in women (1.01 [0.88-1.15]) nor in men (0.74 [0.52-1.04]). Among both genders, waist-to-hip ratio showed the best discriminative ability for diabetes in this population and the optimal cut-off points were ≥ 0.88 in women and ≥ 0.90 in men. Recommended cut-off points for body mass index and waist circumference had a poor predictive ability. CONCLUSION:Our findings suggest that measures of central rather than general obesity relate to type 2 diabetes in SSA. It remains to be verified from larger population-based epidemiological studies whether anthropometric targets of obesity prevention in SSA differ from those in developed countries.

背景与目标： 目的：肥胖症和2型糖尿病的流行在撒哈拉以南非洲（SSA）很明显。但是，在该地区几乎没有检查过它们的关联。
方法：在加纳市区以医院为基础的病例对照研究，由1221名成人（542例和679例对照组）组成，调查了人体测量学参数在糖尿病中的作用。使用逻辑回归进行分析。糖尿病的鉴别力和特定人群的临界点通过接受者的操作特征曲线来确定。
结果：腰臀比与糖尿病的关系最大：女性每1个标准差的年龄校正比值比为1.95（95％置信区间[CI]：1.64-2.31），而女性为1.40 [1.01-1.94] ]的男人。另外，在女性中，糖尿病的几率随着腰围（1.35 [1.17-1.57]）和腰高比（1.29 [1.12-1.50]）的增加而增加。在男人中，这是不明显的。相反，髋围呈负相关（0.69 [0.50-0.95]）。体重指数与女性（1.01 [0.88-1.15]）和男性（0.74 [0.52-1.04]）都不与糖尿病相关。在这两个性别中，腰臀比在该人群中表现出对糖尿病的最佳判别能力，并且最佳的分界点是女性≥0.88，男性≥0.90。推荐的体重指数和腰围临界点的预测能力较差。
结论：我们的研究结果表明，中枢性肥胖而非一般性肥胖与SSA中的2型糖尿病有关。撒哈拉以南非洲地区预防肥胖症的人体测量指标是否与发达国家不同，尚需从更大的基于人群的流行病学研究中得到验证。