BACKGROUND & AIMS: OBJECTIVE:Complementary and alternative medicine (CAM) is widely used in the United States, but information is lacking on CAM use among older minority adults. This analysis documents CAM use among Black, Hispanic, Asian, and White adults age > or =65 and delineates the importance of ethnicity in predicting CAM use. METHODS:Data are from the 2002 National Health Interview Survey (NHIS). The 2002 NHIS oversampled Blacks and Hispanics and included a special module on CAM use. Logistic regression models were fit to examine the effects of ethnicity, sex, age, educational attainment, number of health conditions, and US census region on any CAM use and use of CAM within five major groupings. RESULTS:27.7% of older adults use CAM, with the highest level of use among Asians (48.6%), followed by Hispanics (31.6%), Whites (27.7%), and Blacks (20.5%). Asian elders have significantly greater odds than Whites of using any CAM, alternative medical system, biologically based therapies, and mind-body medicine and lower odds of using body-based and manipulative methods. Hispanic elders have greater odds than Whites of using any CAM and biologically-based therapies. Black elders differ significantly from Whites only in their lesser use of body-based and manipulative methods. Overall, more women than men are CAM users. CAM use declines amongthose age > or =75 years. CONCLUSION:CAM is an important component of older adults' health self-management, and research should examine how they learn about CAM and delineate the decision process in selecting CAM modalities.

背景与目标： 目的：补充和替代医学（CAM）在美国被广泛使用，但是在老年人中缺乏关于CAM使用的信息。该分析记录了年龄≥65岁的黑人，西班牙裔，亚裔和白人成年人中的CAM使用情况，并说明了种族在预测CAM使用情况中的重要性。
方法：数据来自2002年国家健康访问调查（NHIS）。 2002年的NHIS对黑人和西班牙裔进行了超采样，并包括了有关CAM使用的特殊模块。逻辑回归模型适合检验种族，性别，年龄，受教育程度，健康状况和美国人口普查地区对任何CAM使用和在五个主要组中使用CAM的影响。
结果：27.7％的老年人使用CAM，在亚洲人中使用率最高（48.6％），其次是西班牙裔（31.6％），白人（27.7％）和黑人（20.5％）。亚洲老年人与白人相比，使用任何CAM，替代医学系统，基于生物的疗法和心身医学的几率要大得多，而使用基于身体和手法的几率则要低得多。与白人相比，西班牙裔老年人使用任何CAM和基于生物的疗法的可能性更大。黑人长者与白人的显着不同之处仅在于他们较少使用基于身体和操纵的方法。总体而言，使用CAM的女性多于男性。在年龄大于或等于75岁的人群中，CAM的使用率下降。
结论：CAM是老年人健康自我管理的重要组成部分，研究应研究他们如何学习CAM，并描述选择CAM方式的决策过程。

BACKGROUND & AIMS: :Women of African descent have a lower incidence of breast cancer than their white counterparts; however, the overall age-adjusted breast cancer mortality rates are higher. They also present at a younger age, and have more advanced disease that exhibits poor prognostic features including significantly larger tumors of higher grade, higher rates of estrogen receptor and progesterone receptor negativity and a higher rate of p53 mutations and HRAS1 proto-oncogene expression, all of which confer a poor prognosis. While there are many possible contributory factors to the discrepancies in outcome in women of African descent, there is no satisfactory explanation as to why women of African origin tend to present at a younger age with hormone receptor-negative tumors and more adverse prognostic features.

背景与目标： ：非洲裔女性的乳腺癌发病率低于白人女性；但是，按年龄调整的总体乳腺癌死亡率更高。它们也以较年轻的年龄出现，并具有较晚期的疾病，表现出不良的预后特征，包括更高级别的明显更大的肿瘤，更高的雌激素受体和孕激素受体阴性率以及更高的p53突变和HRAS1原癌基因表达率，所有其中预后不良。尽管有许多可能的因素导致非洲人后裔的结果差异，但对于为什么非洲裔妇女倾向于在年轻时出现荷尔蒙受体阴性肿瘤和更不利的预后特征尚无令人满意的解释。

BACKGROUND & AIMS: :The purpose of this study was to compare preferred facial profiles rated by different age groups. An average profile of each gender was constructed from subjects with normal occlusions. Each average profile was located in the centre, and then the lips were protruded or retruded in six 1mm increments in each direction. 70 lay people were divided into 3 groups: young adult (20-39 years); middle-aged (40-54 years); and senior (55-70 years). They were asked to rank their 3 most preferred profiles for each gender. The distribution of the most pleasing profile was compared according to age groups by the Kruskal-Wallis test and according to the rater's gender by the Mann-Whitney U-test. There was a significant difference between the three age groups regarding the preferred male and female profiles (P<0.001). Both the middle-aged and the senior groups tended to select a slightly more retruded lip/flat profile than the young adult group. There was no gender dimorphism in the selection of the preferred profile. The young adult group preferred the straight profile while the middle-aged and senior groups favoured the slightly retruded profile. This may provide useful information for treatment planning in orthodontics and orthognathic surgery.

背景与目标： ：这项研究的目的是比较不同年龄组的首选面部轮廓。从具有正常咬合的受试者中构造出每种性别的平均轮廓。每个平均轮廓位于中心，然后沿每个方向以6个1mm的增量突出或突出嘴唇。 70个外行人分为3组：年轻的成年人（20-39岁）；年轻的成年人（20-39岁）。中年（40-54岁）；和高级（55-70岁）。他们被要求对每种性别的3个最喜欢的个人资料进行排名。 Kruskal-Wallis检验根据年龄组比较了最令人愉快的分布，Mann-Whitney U检验根据评分者的性别进行了比较。三个年龄组之间在偏好的男性和女性形象方面存在显着差异（P <0.001）。中青年组和老年人组都倾向于选择比年轻人组略微突出的嘴唇/扁平轮廓。在选择偏好的个人资料时没有性别二态性。年轻的成年人群喜欢笔直的轮廓，而中年人和老年人群则偏爱略微突出的轮廓。这可能为正畸和正颌外科手术治疗计划提供有用的信息。

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省的种群之间存在系统发育关系，这为该种群与亚美尼亚其他三个集合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: PURPOSE:The aim of this study was to assess the measurement properties of the 5-level classification system of the EQ-5D (5L), in comparison with the 3-level EQ-5D (3L). METHODS:Participants (n = 3,919) from six countries, including eight patient groups with chronic conditions (cardiovascular disease, respiratory disease, depression, diabetes, liver disease, personality disorders, arthritis, and stroke) and a student cohort, completed the 3L and 5L and, for most participants, also dimension-specific rating scales. The 3L and 5L were compared in terms of feasibility (missing values), redistribution properties, ceiling, discriminatory power, convergent validity, and known-groups validity. RESULTS:Missing values were on average 0.8% for 5L and 1.3% for 3L. In total, 2.9% of responses were inconsistent between 5L and 3L. Redistribution from 3L to 5L using EQ dimension-specific rating scales as reference was validated for all 35 3L-5L-level combinations. For 5L, 683 unique health states were observed versus 124 for 3L. The ceiling was reduced from 20.2% (3L) to 16.0% (5L). Absolute discriminatory power (Shannon index) improved considerably with 5L (mean 1.87 for 5L versus 1.24 for 3L), and relative discriminatory power (Shannon Evenness index) improved slightly (mean 0.81 for 5L versus 0.78 for 3L). Convergent validity with WHO-5 was demonstrated and improved slightly with 5L. Known-groups validity was confirmed for both 5L and 3L. CONCLUSIONS:The EQ-5D-5L appears to be a valid extension of the 3-level system which improves upon the measurement properties, reducing the ceiling while improving discriminatory power and establishing convergent and known-groups validity.

背景与目标： 目的：本研究的目的是评估EQ-5D（5L）的5级分类系统与3级EQ-5D（3L）的测量性能。
方法：来自六个国家的参与者（n = 3,919），包括八个患有慢性病（心血管疾病，呼吸系统疾病，抑郁症，糖尿病，肝病，人格障碍，关节炎和中风）的患者组和一个学生队列，完成了3L和5L，对于大多数参与者，还包括特定于维度的等级量表。比较了3L和5L的可行性（缺失值），重新分配属性，上限，区分能力，收敛效度和已知群体效度。
结果：5升漏失平均值平均为3升，漏失值为1.3％。总计2.9％的响应在5L和3L之间不一致。对于所有35种3L-5L级组合，均使用EQ尺寸特定等级量表作为参考，从3L重新分配到5L。对于5升，观察到683个独特的健康状态，而对于3升则观察到124个。上限从20.2％（3L）降低到16.0％（5L）。绝对判别力（Shannon指数）在5L时有显着提高（5L平均值为1.87，3L为1.24），相对判别力（Shannon均匀度指数）略有提高（5L分别为0.81和3L分别为0.78）。证实了与WHO-5的收敛效度，并与5L相比略有改善。 5L和3L均确认了已知组的有效性。
结论：EQ-5D-5L似乎是三级系统的有效扩展，它改善了测量性能，降低了上限，同时提高了鉴别能力，并建立了收敛性和已知群体的有效性。

BACKGROUND & AIMS: BACKGROUND:There is a paucity of published guidelines on managing dyspepsia in general practice. Existing guidelines emphasize the role of investigations and drugs rather than management approaches. Focus groups are a means of uncovering the way in which the participants think and work in the pragmatic-setting, and have not previously been formally used in creating guidelines.

AIM:To develop guidelines for the management of dyspepsia and to assess the use of focus groups of general practitioners (GPs) in order to do so.

METHOD:Initial evidence-based guidelines were proposed by a group of four GPs with an audit facilitator, and used for discussion in three focus groups using a standard format. An anthropological analysis of the proceedings led to modifications of the original guidelines, based on knowledge, perceptions and attitudes. The study was set in three distinct locations involving 30 GPs. The outcome measures consisted of feedback, categorized by types of responses, from the analysis of the focus groups and the creation of guidelines.

RESULTS:The resulting guidelines were patient centred and based on the principles of good consultation. They encompassed patients' fears and doctors' clinical uncertainties, and allowed flexibility in the individual patient's management. The focus group methodology exposed a substantial number of GPs to guideline development, and had the added benefits of dissemination, peer review and educational challenge.

CONCLUSION:It was possible to develop guidelines for dyspepsia using focus groups. The methodology had the added benefits of ownership, peer review, exposure of educational gaps and locality factors, and dissemination of good practice. It included steps from evidence review to implementation strategies. The development of this technique could lead to a strategy towards the creation and application of evidence-based and professionally acceptable clinical guidelines and practice on a locality basis nationally.

背景与目标： 背景：在一般情况下，有关消化不良的已发布指南很少。现有指南强调调查和药物的作用，而不是管理方法。焦点小组是揭示参与者在务实环境中思考和工作方式的一种方式，以前从未在制定指南中正式使用过。

AIM ：要发展

METHOD ：最初的循证指南是由一位专家提出的。一组由审核员协助的四个GP，并使用标准格式在三个焦点小组中进行讨论。对程序的人类学分析导致​​根据知识，看法和态度对原始准则进行了修改。该研究在三个不同的地点进行，涉及30个GP。结果测量包括根据反馈类型进行的反馈，对焦点小组的分析以及指南的创建。

结果：结果指南以患者为中心，基于良好协商的原则。它们涵盖了患者的恐惧和医生的临床不确定性，并允许在个体患者的管理中保持灵活性。焦点小组的方法使大量的GP可以接受指南的制定，并具有传播，同行评审和教育挑战的额外好处。

结论：可以为以下方面制定指南消化不良使用焦点小组。该方法具有所有权，同行评议，暴露教育差距和地区因素以及传播良好实践等附加好处。它包括从证据审查到实施策略的步骤。该技术的发展可能会导致制定在全国范围内基于证据的，专业认可的临床指南和实践的策略。