Delphi-derived development of a common core for measuring complementary and alternative medicine prevalence.

Assessing complementary and alternative medicine (CAM) use remains difficult due to many problems, not the least of which is defining therapies and modalities that should be considered as CAM. Members of the International Society for Complementary Medicine Research (ISCMR) participated in a Delphi process to identify a core listing of common CAM therapies presently in use in Western countries. Lists of practitioner-based and self-administered CAM were constructed based on previous population-based surveys and ranked by ISCMR researchers by perceived level of importance. A total of 64 (49%) ISCMR members responded to the first round of the Delphi process, and 39 of these (61%) responded during the second round. There was agreement across all geographic regions (United States, United Kingdom, Canada, and Western Europe) for the inclusion of herbal medicine, acupuncture, homeopathy, Traditional Chinese Medicine (TCM), chiropractic, naturopathy, osteopathy, Ayurvedic medicine, and massage therapy in the core practitioner-based CAM list, and for homeopathy products, herbal supplements, TCM products, naturopathic products, and nutritional products in the self-administered list. This Delphi process, along with the existing literature, has demonstrated that (1) separate lists are required to measure practitioner-based and self-administered CAM; (2) timeframes should include both ever use and recent use; (3) researchers should measure and report prevalence estimates for each individual therapy so that direct comparisons can be made across studies, time, and populations; (4) the list of CAM therapies should include a core list and additionally those therapies appropriate to the geographic region, population, and the specific research questions addressed, and (5) intended populations and samples studied should be defined by the researcher so that the generalizability of findings can be assessed. Ultimately, it is important to find out what CAM modality people are using and if they are being helped by these interventions.

Continuing bone expansion and increasing bone loss over a two-decade period in men and women from a total community sample.

As shown in 744 adult men and women aged 30-49 at entry and followed for 21.4 ± 0.9 years there is continuing subperiosteal expansion in both sexes as well as continuing and increasing endosteal surface resorption. In this longitudinal study, bone loss (as shown by medullary cavity expansion) begins by the 5th decade and increases thereafter. The smaller gains at the outer bone surface are essentially independent of the larger losses at the inner (endosteal) surface and neither functionally nor causally related. Though bone loss and net bone loss is nearly as great in men as in women, absolutely speaking, two-decade bone loss constitutes a larger percentage of the initially smaller bone mass in the female. In both sexes subperiosteal apposition (delta TA) and endosteal resorption (delta MA) are bone-size dependent though in diametrically opposite directions. These trends in two-decade bone change are not affected by smoking behavior, alcoholic beverage usage, antihypertensive usage, or early menopausal age. Similarly, the long-term bone changes prove to be independent of energy and mineral intakes and to long-term changes in calcium, phosphorus, magnesium, and vitamin D intake. Though dietary intakes do not predict long-term bone changes, the amount of tissue bone present at entry is highly correlated (> 0.93) with tissue bone 21.4 years later in men and women alike. Accordingly, only a small amount of intraindividual cortical variance in the later years still remains to be explained by life-style, dietary, medication, and error variables.

The education of one spouse and the fatness of the other spouse.

As shown in 702 wives with 9-12 years of education and 612 husbands similarly educated, the summed skinfolds of one spouse are influenced by the educational level of the other spouse, considerably so for the husbands. Women with 9-12 years of education married to men of lower educational attainment are higher in the sum of four skinfolds while women of similar years of schooling married to men of college education and beyond are leaner (P=0.001). Possible explanations for the effect of the education of one spouse on the fatness level of the other spouse include selective mating in the direction set by the husband's socioeconomic milieu and fatness "drift" on the part of the wives, again in the direction of the husband's socioeconomic status (SES). While these findings do not lend themselves to a simple biological explanation, they do reiterate the effects of socioeconomic variables on fatness level within populations and even within families.