We may be taught not to judge a book by its cover, but when we see a new face, our brains decide whether a person is attractive and trustworthy within a tenth of a second, according to recent Princeton research. Princeton University psychologist Alex Todorov has found that people respond intuitively to faces so rapidly that our reasoning minds may not have time to influence the reaction -- and that our intuitions about attraction and trust are among those we form the fastest. "The link between facial features and character may be tenuous at best, but that doesn't stop our minds from sizing other people up at a glance," said Todorov, an assistant professor of psychology. "We decide very quickly whether a person possesses many of the traits we feel are important, such as likeability and competence, even though we have not exchanged a single word with them. It appears that we are hard-wired to draw these inferences in a fast, unreflective way." Todorov and co-author Janine Willis, a student researcher who graduated from Princeton in 2005, used timed experiments and found that snap judgments on character are often formed with insufficient time for rational thought. They published their research in the July issue of the journal Psychological Science. The study formed part of Willis' senior thesis work, which was inspired by an earlier paper by Todorov investigating the outcome of a political campaign. "I had done studies with my students that found there was a direct correlation between how competent a campaigning politician's face was and how great his margin of victory turned out in the final election," Todorov said of his earlier work, published in the journal Science last year. "We might assume that our judgments are founded on deliberate and rational thought processes, but observers had made their judgments about politicians based on a one-second look at their faces. I mentioned the findings to Janine, who suggested we look into just how fast we form these (judgments about) character traits." For the current study, the two researchers conducted several experiments on about 200 people. For one experiment, the researchers asked observers to look at 66 different faces for one of three time durations: either 100 milliseconds, 500 milliseconds or a full second. After each face flashed on the screen and vanished, the observers marked whether they found the face to be trustworthy or not, and also how confident they were in their analysis. Other experiments conducted in similar fashion tested for different specific traits, such as likeability and competence. "What we found was that, if given more time, people's fundamental judgment about faces did not change," Todorov said. "Observers simply became more confident in their judgments as the duration lengthened." Why the brain makes such snap judgments is not yet entirely clear, Todorov said. However, he often works with a sophisticated technological tool for probing brain activity called a functional magnetic resonance imager (fMRI), and Todorov said some of his general research suggests that the part of the brain that responds directly to fear may be involved in judgments of trustworthiness. "The fear response involves the amygdala, a part of the brain that existed in animals for millions of years before the development of the prefrontal cortex, where rational thoughts come from," he said. "We imagine trust to be a rather sophisticated response, but our observations indicate that trust might be a case of a high-level judgment being made by a low-level brain structure. Perhaps the signal bypasses the cortex altogether." The research, Todorov said, explores some of the same topics addressed in "Blink," the recent best-selling book by New York journalist Malcolm Gladwell about the rapid cognition our minds experience when making decisions quickly, especially those based on first impressions made in the "blink" of an eye. Gladwell, who is often described as a type of popular sociologist, has said the impetus for his book was the rapid judgments people made about him because of his long hair. "This paper's results concern specific mechanisms in the mind, while 'Blink' makes broader generalizations," Todorov said. "Gladwell's basic message is not essentially different from ours, though he views snap judgments to be primarily rational in nature. Our research finds that this is often the case, but not always." Todorov cautioned that his findings do not imply, however, that quick first impressions cannot be overcome by the rational mind. "As time passes and you get to know people, you, of course, develop a more rounded conception of them," he said. "But because we make these judgments without conscious thought, we should be aware of what is happening when we look at a person's face." What aspects of a face inspire such judgments remain undetermined, Todorov said. "We still don't know the physical features of a face that lead to a particular trait inference," he said. "We know generally what makes a face attractive, such as its symmetry, the proportions of its parts and the like. But what is it about a face that makes you think its owner is an essentially competent person? That's the subject of another study, one that needs to be done." This research was sponsored in part by the National Science Foundation. Abstract First Impressions: Making Up Your Mind After a 100-Ms Exposure to a Face Janine Willis and Alexander Todorov, Princeton University People often draw trait inferences from the facial appearance of other people. We investigated the minimal conditions under which people make such inferences. In five experiments, each focusing on a specific trait judgment, we manipulated the exposure time of unfamiliar faces. Judgments made after a 100-ms exposure correlated highly with judgments made in the absence of time constraints, suggesting that this exposure time was sufficient for participants to form an impression. In fact, for all judgments — attractiveness, likeability, trustworthiness, competence, and aggressiveness—increased exposure time did not significantly increase the correlations. When exposure time increased from 100 to 500 ms, participants’ judgments became more negative, response times for judgments decreased, and confidence in judgments increased. When exposure time increased from 500 to 1,000 ms, trait judgments and response times did not change significantly (with one exception), but confidence increased for some of the judgments; this result suggests that additional time may simply boost confidence in judgments. However, increased exposure time led to more differentiated person impressions.

WASHINGTON -- Medication errors are among the most common medical errors, harming at least 1.5 million people every year, says a new report from the Institute of Medicine of the National Academies. The extra medical costs of treating drug-related injuries occurring in hospitals alone conservatively amount to $3.5 billion a year, and this estimate does not take into account lost wages and productivity or additional health care costs, the report says. The committee that wrote the report recommended a series of actions for patients, health care organizations, government agencies, and pharmaceutical companies. The recommendations include steps to increase communication and improve interactions between health care professionals and patients, as well as steps patients should take to protect themselves. The report also recommends the creation of new, consumer-friendly information resources through which patients can obtain objective, easy-to-understand drug information. In addition, it calls for all prescriptions to be written electronically by 2010 and suggests ways to improve the naming, labeling, and packaging of drugs to reduce confusion and prevent errors. "The frequency of medication errors and preventable adverse drug events is cause for serious concern," said committee co-chair Linda R. Cronenwett, dean and professor, School of Nursing, University of North Carolina, Chapel Hill. "We need a comprehensive approach to reducing these errors that involves not just health care organizations and federal agencies, but the industry and consumers as well," she said. Co-chair J. Lyle Bootman, dean and professor, College of Pharmacy, University of Arizona, Tucson, added, "Our recommendations boil down to ensuring that consumers are fully informed about how to take medications safely and achieve the desired results, and that health care providers have the tools and data necessary to prescribe, dispense, and administer drugs as safely as possible and to monitor for problems. The ultimate goal is to achieve the best care and outcomes for patients each time they take a medication." Estimates of Rates and Costs Medication errors encompass all mistakes involving prescription drugs, over-the-counter products, vitamins, minerals, or herbal supplements. Errors are common at every stage, from prescription and administration of a drug to monitoring of the patient's response, the committee found. It estimated that on average, there is at least one medication error per hospital patient per day, although error rates vary widely across facilities. Not all errors lead to injury or death, but the number of preventable injuries that do occur -- the committee estimated at least 1.5 million each year -- is sobering, the report says. Studies indicate that 400,000 preventable drug-related injuries occur each year in hospitals. Another 800,000 occur in long-term care settings, and roughly 530,000 occur just among Medicare recipients in outpatient clinics. The committee noted that these are likely underestimates. There is insufficient data to determine accurately all the costs associated with medication errors. The conservative estimate of 400,000 preventable drug-related injuries in hospitals will result in at least $3.5 billion in extra medical costs this year, the committee calculated. A study of outpatient clinics found that medication-related injuries there resulted in roughly $887 million in extra medical costs in 2000 -- and the study looked only at injuries experienced by Medicare recipients, a subset of clinic visitors. None of these figures take into account lost wages and productivity or other costs. Improving the Patient-Provider Partnership Establishing and maintaining strong partnerships between health care providers and patients is crucial to reducing medication errors, the report says. The committee called on consumers to be active partners in their medication care and on physicians, nurses, and pharmacists to know and act on patients' medical care rights. The report recommends specific steps that physicians, nurses, pharmacists, and other health professionals should take to ensure that their patients are fully informed about their drug regimens and to minimize opportunities for mistakes to occur. Health care organizations also should make it a standard procedure to inform patients about clinically significant medication errors made in their care, whether the mistakes lead to harm or not. Currently, health care providers typically do not inform the patient or the patient's guardians about errors unless injury or death results. The report also provides consumers with a list of specific questions to ask health care providers, such as how to take their medications properly and what to do if side effects occur. Also included are actions consumers should take, such as requesting that their providers give them a printed record of the drugs they have been prescribed. Patients should maintain an up-to-date list of all medications they use -- including over-the-counter products and dietary supplements -- and share it with all their health care providers. This list should also note the reasons they are taking each product and any drug and food allergies they have. New and Improved Drug Information Resources Although consumers can find helpful drug information online or in the printed materials provided by pharmacies, this information often is too difficult for many people to understand, too scattered, or otherwise not consumer-friendly. The quality of the drug information leaflets that accompany prescriptions varies widely, and these printouts are typically written at a college reading level. The U.S. Food and Drug Administration (FDA) should work with other appropriate groups to standardize the text and design of medication leaflets to ensure that they are comprehensible and useful to all consumers. The committee called on the National Library of Medicine (NLM) to be the chief agency responsible for online health resources for consumers; it should create a Web site to serve as a centralized source of comprehensive, objective, and easy-to-understand information about drugs for consumers. In addition, NLM should work with other groups to evaluate online health information and designate Web sites that provide reliable information. The committee also recommended that NLM, FDA, and the Centers for Medicare and Medicaid Services evaluate ways to build and fund a national network of telephone helplines to assist people who may not be able to access or understand printed medication information because of illiteracy, language barriers, or other obstacles. This telephone network should also enable consumers to report medication-related mistakes or problems. Electronic Prescribing and Other IT Solutions New computerized systems for prescribing drugs and other applications of information technology show promise for reducing the number of drug-related mistakes, the report says. Studies indicate that paper-based prescribing is associated with high error rates. Electronic prescribing is safer because it eliminates problems with handwriting legibility and, when combined with decision-support tools, automatically alerts prescribers to possible interactions, allergies, and other potential problems, the committee found. While it acknowledged that significant regulatory issues and problems with automated alerts still need to be worked out, the committee said that by 2008 all health care providers should have plans in place to write prescriptions electronically. By 2010 all providers should be using e-prescribing systems and all pharmacies should be able to receive prescriptions electronically. The Agency for Healthcare Research and Quality (AHRQ) should take the lead in fostering improvements in IT systems used in ordering, administering, and monitoring drugs. All health care provider groups should be actively monitoring their progress in improving medication safety, the committee recommended. Monitoring efforts might include computer systems that detect medication-related problems and periodic audits of prescriptions filled in community pharmacies. Drug Naming, Labeling, and Packaging Confusion caused by similar drug names accounts for up to 25 percent of all errors reported to the Medication Error Reporting Program operated cooperatively by U.S. Pharmacopeia (USP) and the Institute for Safe Medication Practices (ISMP). In addition, labeling and packaging issues were cited as the cause of 33 percent of errors, including 30 percent of fatalities, reported to the program. Drug naming terms should be standardized as much as possible, and all companies should be required to use the standardized terms, the report urges. FDA, AHRQ, and the pharmaceutical industry should collaborate with USP, ISMP, and other appropriate organizations to develop a plan to address the problems associated with drug naming, labeling, and packaging by the end of 2007. The report also recommends studies to evaluate the impact of free drug samples on overall medication safety. In general, there has been growing unease among health care providers and others about the way free samples are distributed and the resulting lack of documentation of medication use, as well as the bypassing of drug-interaction checks and counseling that are integral parts of the standard prescription process. The study was sponsored by the U.S. Department of Health and Human Services and Centers for Medicare and Medicaid Services. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. A committee roster follows. INSTITUTE OF MEDICINE Board on Health Care Services Committee on Identifying and Preventing Medication Errors J. Lyle Bootman, Ph.D., Sc.D., (co-chair) Dean and Professor University of Arizona College of Pharmacy, and Founding and Executive Director University of Arizona Center for Health Outcomes and PharmacoEconomic Research Tucson Linda R. Cronenwett, R.N., Ph.D. (co-chair) Professor and Dean School of Nursing University of North Carolina Chapel Hill David W. Bates, M.D., M.Sc. Chief Division of General Medicine Brigham and Women’s Hospital; Medical Director of Clinical and Quality Analysis Partners Healthcare System; and Professor of Medicine Harvard Medical School Boston Robert M. Califf, M.D. Associate Vice Chancellor for Clinical Research; Director Duke Clinical Research Institute; and Professor of Medicine Division of Cardiology Duke University Medical Center Durham, N.C. H. Eric Cannon, Pharm.D. Director of Pharmacy Services and Health and Wellness IHC Health Plans Intermountain Health Care Salt Lake City Rebecca W. Chater, M.P.H. Director of Clinical Services Kerr Drug Inc. Asheville, N.C. Michael R. Cohen, Sc.D. President Institute for Safe Medication Practices Huntington Valley, Pa. James B. Conway, M.S. Senior Fellow Institute for Healthcare Improvement, and Senior Consultant Dana-Farber Cancer Institute Boston R. Scott Evans, Ph.D. Senior Medical Informaticist Department of Medical Informatics LDS Hospital and Intermountain Health Care, and Professor Department of Medical Informatics University of Utah Salt Lake City Elizabeth A. Flynn, Ph.D., R.Ph. Associate Research Professor Department of Pharmacy Care Systems Harrison School of Pharmacy Auburn University Auburn, Ala. Jerry H. Gurwitz, M.D. Chief Division of Geriatric Medicine; Dr. John Meyers Professor of Primary Care Medicine; and Executive Director Meyers Primary Care Institute University of Massachusetts Medical School Worcester Charles B. Inlander President People’s Medical Society Allentown, Pa. Kevin B. Johnson, M.D., M.S. Associate Professor and Vice Chair Department of Biomedical Informatics, and Associate Professor Department of Pediatrics Vanderbilt University Medical School Nashville, Tenn. Wilson D. Pace, M.D. Professor of Family Medicine and Green-Edelman Chair for Practice-based Research University of Colorado, and Director National Research Network American Academy of Family Physicians Aurora, Colo. Kathleen R. Stevens, Ed.D., R.N. Professor and Director Academic Center for Evidence-Based Practice University of Texas Health Science Center San Antonio Edward Westrick, M.D., Ph.D. Vice President of Medical Management University of Massachusetts Memorial Health Care Worcester Albert W. Wu, M.D. Professor of Health Policy and Management and Internal Medicine Johns Hopkins University Baltimore INSTITUTE STAFF Philip Aspden, Ph.D. Study Director Pre-publication copies of Preventing Medication Errors are available from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or on the Internet at http://www.nap.edu. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).

According to a study released on Monday April 3, 2006 by HealthGrades medical errors remain a leading cause of death and injury at hospitals nationwide. New York hospitals ranked at the bottom when it comes to keeping patients from developing complications or new infections while in the hospital. To read the full study click on the link below. Third Annual Patient Safety in American Hospitals Study Note: You must have Adobe Acrobat Reader to view the study.

A Randomized Controlled Trial Context Prolonged calorie restriction increases life span in rodents. Whether prolonged calorie restriction affects biomarkers of longevity or markers of oxidative stress, or reduces metabolic rate beyond that expected from reduced metabolic mass, has not been investigated in humans. Objective To examine the effects of 6 months of calorie restriction, with or without exercise, in overweight, nonobese (body mass index, 25 to <30) men and women. Design, Setting, and Participants Randomized controlled trial of healthy, sedentary men and women (N = 48) conducted between March 2002 and August 2004 at a research center in Baton Rouge, La. Intervention Participants were randomized to 1 of 4 groups for 6 months: control (weight maintenance diet); calorie restriction (25% calorie restriction of baseline energy requirements); calorie restriction with exercise (12.5% calorie restriction plus 12.5% increase in energy expenditure by structured exercise); very low-calorie diet (890 kcal/d until 15% weight reduction, followed by a weight maintenance diet). Main Outcome Measures Body composition; dehydroepiandrosterone sulfate (DHEAS), glucose, and insulin levels; protein carbonyls; DNA damage; 24-hour energy expenditure; and core body temperature. Results Mean (SEM) weight change at 6 months in the 4 groups was as follows: controls, –1.0% (1.1%); calorie restriction, –10.4% (0.9%); calorie restriction with exercise, –10.0% (0.8%); and very low-calorie diet, –13.9% (0.7%). At 6 months, fasting insulin levels were significantly reduced from baseline in the intervention groups (all P<.01), whereas DHEAS and glucose levels were unchanged. Core body temperature was reduced in the calorie restriction and calorie restriction with exercise groups (both P<.05). After adjustment for changes in body composition, sedentary 24-hour energy expenditure was unchanged in controls, but decreased in the calorie restriction (–135 kcal/d [42 kcal/d]), calorie restriction with exercise (–117 kcal/d [52 kcal/d]), and very low-calorie diet (–125 kcal/d [35 kcal/d]) groups (all P<.008). These "metabolic adaptations" (~ 6% more than expected based on loss of metabolic mass) were statistically different from controls (P<.05). Protein carbonyl concentrations were not changed from baseline to month 6 in any group, whereas DNA damage was also reduced from baseline in all intervention groups (P <.005). Conclusions Our findings suggest that 2 biomarkers of longevity (fasting insulin level and body temperature) are decreased by prolonged calorie restriction in humans and support the theory that metabolic rate is reduced beyond the level expected from reduced metabolic body mass. Studies of longer duration are required to determine if calorie restriction attenuates the aging process in humans. JAMA. 2006;295:1539-1548.

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We incorporated the views of patients to develop a comprehensive set of ideal physician behaviors. Telephone interviews were conducted in 2001 and 2002 with a random sample of 192 patients who were seen in 14 different medical specialties of Mayo Clinic in Scottsdale, Ariz, and Mayo Clinic in Rochester, Minn. Interviews focused on the physician-patient relationship and lasted between 20 and 50 minutes. Patients were asked to describe their best and worst experiences with a physician in the Mayo Clinic system and to give specifics of the encounter. The interviewers independently generated and validated 7 ideal behavioral themes that emerged from the interview transcripts. The ideal physician is confident, empathetic, humane, personal, forthright, respectful, and thorough. Ways that physicians can incorporate clues to the 7 ideal physician behaviors to create positive relationships with patients are suggested. Mayo Clin Proc. 2006;81(3):338-344 To read a review by Ann Edmundson, MD click on the link below.

The Women's Health Initiative Randomized Controlled Dietary Modification Trial ABSTRACT Context The hypothesis that a low-fat dietary pattern can reduce breast cancer risk has existed for decades but has never been tested in a controlled intervention trial. Objective To assess the effects of undertaking a low-fat dietary pattern on breast cancer incidence. Design and Setting A randomized, controlled, primary prevention trial conducted at 40 US clinical centers from 1993 to 2005. Participants A total of 48 835 postmenopausal women, aged 50 to 79 years, without prior breast cancer, including 18.6% of minority race/ethnicity, were enrolled. Interventions Women were randomly assigned to the dietary modification intervention group (40% [n = 19 541]) or the comparison group (60% [n = 29 294]). The intervention was designed to promote dietary change with the goals of reducing intake of total fat to 20% of energy and increasing consumption of vegetables and fruit to at least 5 servings daily and grains to at least 6 servings daily. Comparison group participants were not asked to make dietary changes. Main Outcome Measure Invasive breast cancer incidence. Results Dietary fat intake was significantly lower in the dietary modification intervention group compared with the comparison group. The difference between groups in change from baseline for percentage of energy from fat varied from 10.7% at year 1 to 8.1% at year 6. Vegetable and fruit consumption was higher in the intervention group by at least 1 serving per day and a smaller, more transient difference was found for grain consumption. The number of women who developed invasive breast cancer (annualized incidence rate) over the 8.1-year average follow-up period was 655 (0.42%) in the intervention group and 1072 (0.45%) in the comparison group (hazard ratio, 0.91; 95% confidence interval, 0.83-1.01 for the comparison between the 2 groups). Secondary analyses suggest a lower hazard ratio among adherent women, provide greater evidence of risk reduction among women having a high-fat diet at baseline, and suggest a dietary effect that varies by hormone receptor characteristics of the tumor. Conclusions Among postmenopausal women, a low-fat dietary pattern did not result in a statistically significant reduction in invasive breast cancer risk over an 8.1-year average follow-up period. However, the nonsignificant trends observed suggesting reduced risk associated with a low-fat dietary pattern indicate that longer, planned, nonintervention follow-up may yield a more definitive comparison. Ross L. Prentice, PhD; Bette Caan, DrPH; Rowan T. Chlebowski, MD; Ruth Patterson, PhD; Lewis H. Kuller, MD; Judith K. Ockene, PhD; Karen L. Margolis, MD; Marian C. Limacher, MD; JoAnn E. Manson, MD; Linda M. Parker, DSc; Electra Paskett, PhD; Lawrence Phillips, MD; John Robbins, MD; Jacques E. Rossouw, MD; Gloria E. Sarto, MD; James M. Shikany, DrPH; Marcia L. Stefanick, PhD; Cynthia A. Thomson, PhD; Linda Van Horn, PhD; Mara Z. Vitolins, DrPH; Jean Wactawski-Wende, PhD; Robert B. Wallace, MD; Sylvia Wassertheil-Smoller, PhD; Evelyn Whitlock, MD; Katsuhiko Yano, MD; Lucile Adams-Campbell, PhD; Garnet L. Anderson, PhD; Annlouise R. Assaf, PhD; Shirley A. A. Beresford, PhD; Henry R. Black, MD; Robert L. Brunner, PhD; Robert G. Brzyski, MD; Leslie Ford, MD; Margery Gass, MD; Jennifer Hays, PhD; David Heber, MD; Gerardo Heiss, MD; Susan L. Hendrix, DO; Judith Hsia, MD; F. Allan Hubbell, MD; Rebecca D. Jackson, MD; Karen C. Johnson, MD; Jane Morley Kotchen, MD; Andrea Z. LaCroix, PhD; Dorothy S. Lane, MD; Robert D. Langer, MD; Norman L. Lasser, MD; Maureen M. Henderson, MD JAMA. 2006;295:629-642. FOR FREE FULL TEXT CLICK ON THE LINK BELOW:

Abstract: Objectives: We sought to compare the therapeutic benefits of ThermaCare Heat Wrap combined with an education program to an education-only program on reducing pain and disability from acute work-related low back pain. Methods: Forty-three eligible patients, aged 20 to 62 years who presented to an occupational injury clinic, were randomized into one of two intervention arms: 1) education regarding back therapy and pain management alone or 2) education regarding back therapy and pain management combined with three consecutive days of topical heat therapy (104[degrees]F or 40[degrees]C for 8 hours). The primary endpoints in this trial were measures of pain intensity and pain relief levels obtained approximately four times per day for the three consecutive working days of treatment, followed by measures of pain intensity and pain relief levels obtained in three follow-up visits at day 4 and 14 from treatment initiation. The secondary measures were overall impairment due to injury and disability caused by low back pain assessed at Intake, Visit 2 (day 4), 3 (day 7), and 4 (day 14). Results and Conclusion: A total of 18 individuals enrolled in the education-only group and 25 in the treatment group completed the intervention and all follow-up visits. The general linear model adjusting for age, sex, baseline pain intensity, and pain medication indicated that the topical heat therapy had significantly reduced pain intensity, increased pain relief, and improved disability scores during and after treatment. Journal of Occupational & Environmental Medicine. 47(12):1298-1306, December 2005.

Abstract BACKGROUND AND PURPOSE: Whether vertebroplasty increases the risk of adjacent-level vertebral fractures remains uncertain. Biomechanical and clinical studies suggest an increased risk, but compelling data have not yet been put forth to settle this difficult issue. We believe that an analysis of the time interval between vertebroplasty and subsequent fractures may shed additional light on this debate. We specifically hypothesized that subsequent fractures would occur sooner and more frequently in the vertebrae adjacent to the treated level. METHODS: We performed a retrospective analysis of the risk and timing of subsequent fractures in patients previously treated with vertebroplasty. Multiple linear regression was used to explore factors that influence the time to new fracture following vertebroplasty. Fractures were then divided on the basis of whether they occurred adjacent or nonadjacent to the treated level. Survival analysis was used to compare time to new fracture among the 2 groups, and the relative risk of both types of fracture was calculated. RESULTS: In this study, 186 new vertebral fractures occurred in 86 (19.9%) of 432 patients. Seventy-seven (41.4%) fractures were of vertebrae adjacent to the level treated with vertebroplasty. Median times until diagnosis of new adjacent and nonadjacent level fractures were 55 days and 127 days, respectively. Time to fracture was significantly different between the 2 groups (logrank <0.0001). Distance of the new fracture from the treated level was also significantly associated with time to new fracture (P < .0001). Relative risk of adjacent level fracture was 4.62 times that for nonadjacent level fracture. CONCLUSION: These data demonstrate an association between vertebroplasty and new vertebral fractures. Specifically, following vertebroplasty, patients are at increased risk of new-onset adjacent-level fractures and, when these fractures occur, they occur sooner than nonadjacent level fractures. American Journal of Neuroradiology 27:217-223, January 2006

ABSTRACT OBJECTIVES: We determined whether caloric restriction (CR) has cardiac-specific effects that attenuate the established aging-associated impairments in diastolic function (DF). BACKGROUND: Caloric restriction retards the aging process in small mammals; however, no information is available on the effects of long-term CR on human aging. In healthy individuals, Doppler echocardiography has established the pattern of aging-associated DF impairment, whereas little change is observed in systolic function (SF). METHODS: Diastolic function was assessed in 25 subjects (age 53 ± 12 years) practicing CR for 6.5 ± 4.6 years and 25 age- and gender-matched control subjects consuming Western diets. Diastolic function was quantified by transmitral flow, Doppler tissue imaging, and model-based image processing (MBIP) of E waves. C-reactive protein (CRP), tumor necrosis factor-alpha (TNF- ), and transforming growth factor-beta1 (TGF-ß1) were also measured. RESULTS: No difference in SF was observed between groups; however, standard transmitral Doppler flow DF indexes of the CR group were similar to those of younger individuals, and MBIP-based, flow-derived DF indexes, reflecting chamber viscoelasticity and stiffness, were significantly lower than in control subjects. Blood pressure, serum CRP, TNF- , and TGF-ß1 levels were significantly lower in the CR group (102 ± 10/61 ± 7 mm Hg, 0.3 ± 0.3 mg/l, 0.8 ± 0.5 pg/ml, 29.4 ± 6.9 ng/ml, respectively) compared with the Western diet group (131 ± 11/83 ± 6 mm Hg, 1.9 ± 2.8 mg/l, 1.5 ± 1.0 pg/ml, 35.4 ± 7.1 ng/ml, respectively). CONCLUSIONS: Caloric restriction has cardiac-specific effects that ameliorate aging-associated changes in DF. These beneficial effects on cardiac function might be mediated by the effect of CR on blood pressure, systemic inflammation, and myocardial fibrosis. Abbreviations and Acronyms BMI = body mass index CR = caloric restriction CRP = C-reactive protein DF = diastolic function LV = left ventricle/ventricular MBIP = model-based image processing SF = systolic function TDI = tissue Doppler imaging TGF-ß1 = transforming growth factor-beta1 TNF- = tumor necrosis factor-alpha WD = Western diet J Am Coll Cardiol, 2006; 47:398-402

ABSTRACT Background Findings from epidemiological studies suggest an inverse relationship between individuals’ protein intake and their blood pressure. Methods Cross-sectional epidemiological study of 4680 persons, aged 40 to 59 years, from 4 countries. Systolic and diastolic blood pressure was measured 8 times at 4 visits. Dietary intake based on 24-hour dietary recalls was recorded 4 times. Information on dietary supplements was noted. Two 24-hour urine samples were obtained per person. Results There was a significant inverse relationship between vegetable protein intake and blood pressure. After adjusting for confounders, blood pressure differences associated with higher vegetable protein intake of 2.8% kilocalories were –2.14 mm Hg systolic and –1.35 mm Hg diastolic (PConclusions Vegetable protein intake was inversely related to blood pressure. This finding is consistent with recommendations that a diet high in vegetable products be part of healthy lifestyle for prevention of high blood pressure and related diseases. Archives of Internal Medicine 2006;166:79-87

ABSTRACT Background Screening for prostate cancer is done commonly in clinical practice, using prostate-specific antigen (PSA) tests or digital rectal examination (DRE). Evidence is lacking, however, to confirm a survival benefit among screened patients. We evaluated the effectiveness of PSA, with or without DRE, in reducing mortality. Methods We conducted a multicenter nested case-control study at 10 Veterans Affairs medical centers in New England. Among 71 661 patients receiving ambulatory care between 1989 and 1990, 501 case patients were identified as men who were diagnosed as having adenocarcinoma of the prostate from 1991 through 1995 and who died sometime between 1991 and 1999. Control patients were men who were alive at the time the corresponding case patient had died, matched (1:1 ratio) for age and Veterans Affairs facility. The exposure variable (determined blind to case-control status) was whether PSA testing or DRE was performed for screening prior to the diagnosis of prostate cancer among case patients, with the same time interval for control patients. The association of screening and overall or cause-specific (prostate cancer) mortality was adjusted for race and comorbidity. Results A benefit of screening was not found in our primary analysis assessing PSA screening and all-cause mortality (adjusted odds ratio, 1.08; 95% confidence interval, 0.71-1.64; P = .72), nor in a secondary analysis of PSA and/or DRE screening and cause-specific mortality (adjusted odds ratio, 1.13; 95% confidence interval, 0.63-2.06; P = .68). Conclusions These results do not suggest that screening with PSA or DRE is effective in reducing mortality. Recommendations for obtaining "verbal informed consent" from men regarding such screening should continue. Arch Intern Med. 2006;166:38-43.

New evidence-based guidelines issued by the American College of Chest Physicians (ACCP) provide the most comprehensive recommendations for the diagnosis and management of cough in adults and children, including specific recommendations for the prevention of whooping cough in adults. Diagnosis and Management of Cough: Evidence-Based Clinical Practice Guidelines is published as a supplement to the January issue of CHEST, the peer-reviewed journal of the ACCP. “Cough is the number one reason why patients seek medical attention. Although an occasional cough is normal, excessive coughing or coughing that produces blood, or thick, discolored mucus is abnormal,” said Chair of the guidelines Richard S. Irwin, MD, FCCP, University of Massachusetts Medical School, Worcester, MA “The new ACCP guidelines define how physicians should diagnose and manage cough associated with everything from the common cold to chronic lung conditions. The guidelines also are the most comprehensive evidence-based recommendations for treating cough in children.” The ACCP cough guidelines put new emphasis on the prevention of whooping cough in adults and address the role of over-the-counter (OTC) cough medications in both adults and children. The guidelines also include more than 200 recommendations for diagnosing and managing acute cough (a cough that lasts for less than 3 weeks), subacute cough (a cough that lasts 3 8 weeks), and chronic cough (a cough that lasts for more than 8 weeks) in adults and children. WHOOPING COUGH The guidelines strongly recommend that adults up to 65 years old receive a new adult vaccine for whooping cough (pertussis), a highly contagious type of subacute cough that gets its name from the loud “whooping” noise patients make when they cough. Because antibiotics are only effective early on in the infection, preventing whooping cough with a vaccine is the only way to eventually eliminate the disease. Once whooping cough takes hold, the coughing patient is at risk of serious complications of coughing, such as vomiting, breaking ribs, passing out, and passing the infection on to others. “Most of us think of whooping cough as a childhood disease, yet 28 percent of whooping cough cases in the United States is in adults,” said Dr. Irwin. “Although most of us were vaccinated against whooping cough when we were children, the older vaccine only gives protection for less than 10 years. Because the older vaccine caused serious side effects when given to older children and adults, it was only given to children. Fortunately, there is a now a new safe and effective whooping cough vaccine that can prevent adults from contracting this disease.” OTC COUGH MEDICATION The guidelines also stress that most over-the-counter cough expectorants or suppressants, including cough syrups and cough drops, do not treat the underlying cause of the cough. Therefore, the guidelines recommend that for adults with acute cough or upper airway cough syndrome (previously named postnasal drip syndrome), an older variety antihistamine with a decongestant is the preferred therapy. “There is no clinical evidence that over-the-counter cough expectorants or suppressants actually relieve cough,” said Dr. Irwin. “There is considerable evidence that older type antihistamines help to reduce cough, so, unless there are contraindications to using these medicines, why not take something that has been proven to work?” PEDIATRIC RECOMMENDATIONS The ACCP guidelines are the first to provide comprehensive, specific, evidence-based recommendations for the diagnosis and management of cough in children. Although the guidelines address all types of pediatric cough, they make a strong recommendation against the use of OTC cough and cold medications for children age 14 years and younger. “Cough is very common in children. However, cough and cold medicines are not useful in children and can actually be harmful,” said Dr. Irwin. “In most cases, a cough that is unrelated to chronic lung conditions, environmental influences, or other specific factors, will resolve on its own.” Of the estimated 829 million visits to office-based physicians in the United States, approximately 29.5 million are for cough. Additional recommendations address the most common causes of chronic cough, including upper airway cough syndrome (previously named postnasal drip syndrome), asthma, and gastroesophageal reflux disease (GERD). Chronic cough also may be a result of smoking or taking angiotensin-converting enzyme (ACE) inhibitors. An acute cough is generally caused by a “common cold”; a subacute cough can linger after a cold or may persist due to a respiratory tract infection, such as whooping cough or other postinfectious cough. “Chronic cough can significantly compromise quality of life for patients. However, patients with chronic cough do not have to continue suffering from their condition,” said W. Michael Alberts, MD, FCCP, President of the American College of Chest Physicians. “The new ACCP guidelines provide clinicians with proven methods of identifying and treating the underlying causes of chronic cough, ultimately, leading to more effective management of chronic cough and better quality of life for patients.” Endorsed by the American Thoracic Society and the Canadian Thoracic Society, the new ACCP cough guidelines were developed by an international committee of individuals with expertise and research experience related to cough from the fields of adult and pediatric pulmonology and respirology, pharmacology, neurology, speech and swallowing, and anatomy and physiology. CHEST is a peer-reviewed journal published by the ACCP. It is available online each month at www.chestjournal.org. The ACCP represents 16,500 members who provide clinical respiratory, sleep, critical care, and cardiothoracic patient care in the United States and throughout the world. The ACCP’s mission is to promote the prevention and treatment of diseases of the chest through leadership, education, research, and communication. For more information about the ACCP, please visit the ACCP Web site at:

Summary Background Vitamin D insufficiency is common in women of childbearing age and increasing evidence suggests that the risk of osteoporotic fracture in adulthood could be determined partly by environmental factors during intrauterine and early postnatal life. We investigated the effect of maternal vitamin D status during pregnancy on childhood skeletal growth. Methods In a longitudinal study, we studied 198 children born in 1991–92 in a hospital in Southampton, UK; the body build, nutrition, and vitamin D status of their mothers had been characterised during pregnancy. The children were followed up at age 9 years to relate these maternal characteristics to their body size and bone mass. Findings 49 (31%) mothers had insufficient and 28 (18%) had deficient circulating concentrations of 25(OH)-vitamin D during late pregnancy. Reduced concentration of 25(OH)-vitamin D in mothers during late pregnancy was associated with reduced whole-body (r=0•21, p=0•0088) and lumbar-spine (r=0•17, p=0•03) bone-mineral content in children at age 9 years. Both the estimated exposure to ultraviolet B radiation during late pregnancy and the maternal use of vitamin D supplements predicted maternal 25(OH)-vitamin D concentration (p<0•0001 and p=0•0110, respectively) and childhood bone mass (p=0•0267). Reduced concentration of umbilical-venous calcium also predicted reduced childhood bone mass (p=0•0286). Interpretation Maternal vitamin D insufficiency is common during pregnancy and is associated with reduced bone-mineral accrual in the offspring during childhood; this association is mediated partly through the concentration of umbilical venous calcium. Vitamin D supplementation of pregnant women, especially during winter months, could lead to longlasting reductions in the risk of osteoporotic fracture in their offspring. The Lancet 2006; 367:36-43

Abstract Vitamin D status differs by latitude and race, with residents of the northeastern United States and individuals with more skin pigmentation being at increased risk of deficiency. A PubMed database search yielded 63 observational studies of vitamin D status in relation to cancer risk, including 30 of colon, 13 of breast, 26 of prostate, and 7 of ovarian cancer, and several that assessed the association of vitamin D receptor genotype with cancer risk. The majority of studies found a protective relationship between sufficient vitamin D status and lower risk of cancer. The evidence suggests that efforts to improve vitamin D status, for example by vitamin D supplementation, could reduce cancer incidence and mortality at low cost, with few or no adverse effects. American Journal of Public Health, 10.2105/AJPH.2004.045260

ABSTRACT Background: Previous studies have suggested that the obstructive sleep apnea syndrome may be an important risk factor for stroke. It has not been determined, however, whether the syndrome is independently related to the risk of stroke or death from any cause after adjustment for other risk factors, including hypertension. Methods: In this observational cohort study, consecutive patients underwent polysomnography, and subsequent events (strokes and deaths) were verified. The diagnosis of the obstructive sleep apnea syndrome was based on an apnea-hypopnea index of 5 or higher (five or more events per hour); patients with an apnea-hypopnea index of less than 5 served as the comparison group. Proportional-hazards analysis was used to determine the independent effect of the obstructive sleep apnea syndrome on the composite outcome of stroke or death from any cause. Results: Among 1022 enrolled patients, 697 (68 percent) had the obstructive sleep apnea syndrome. At baseline, the mean apnea-hypopnea index in the patients with the syndrome was 35, as compared with a mean apnea-hypopnea index of 2 in the comparison group. In an unadjusted analysis, the obstructive sleep apnea syndrome was associated with stroke or death from any cause (hazard ratio, 2.24; 95 percent confidence interval, 1.30 to 3.86; P=0.004). After adjustment for age, sex, race, smoking status, alcohol-consumption status, body-mass index, and the presence or absence of diabetes mellitus, hyperlipidemia, atrial fibrillation, and hypertension, the obstructive sleep apnea syndrome retained a statistically significant association with stroke or death (hazard ratio, 1.97; 95 percent confidence interval, 1.12 to 3.48; P=0.01). In a trend analysis, increased severity of sleep apnea at baseline was associated with an increased risk of the development of the composite end point (P=0.005). Conclusions: The obstructive sleep apnea syndrome significantly increases the risk of stroke or death from any cause, and the increase is independent of other risk factors, including hypertension. The New England Journal of Medicine. November 10, 2005; Vol. 353; No. 19, pp. 2034-2041.

(Embargoed) CHAPEL HILL -- People without enough selenium in their bodies face a higher risk of knee osteoarthritis, a first-of-its-kind new study suggests. University of North Carolina at Chapel Hill Thurston Arthritis Center medical scientists and colleagues conducted the research. It focused on the knees of 940 participants enrolled in the Johnston County (N.C.) Osteoarthritis Project, a continuing, federally supported investigation of osteoarthritis that began 15 years ago and is headquartered at UNC. Scientists found that for every additional tenth of a part per million of selenium in volunteers' bodies, there was a 15 percent to 20 percent decrease in their risk of knee osteoarthritis. Those who had less of the trace mineral than normal in their systems faced a higher risk of the degenerative condition in one and both knees. The severity of their arthritis was related to how low their selenium levels were. "We are very excited about these findings because no one had ever measured body selenium in this way in relationship to osteoarthritis," said study leader Dr. Joanne Jordan of UNC. "Our results suggest that we might be able to prevent or delay osteoarthritis of the knees and possibly other joints in some people if they are not getting enough selenium. That's important because the condition, which makes walking painful, is the leading cause of activity limitation among adults in developed countries." Jordan is associate professor of medicine and orthopaedics at the UNC School of Medicine. Also associate director of the school's Thurston Arthritis Research Center, she is principal investigator of the long-term Johnston County Osteoarthritis Project. That investigation is the largest and longest of its kind ever done and has involved some 4,400 volunteers, both blacks and whites, whose experiences with arthritis doctors follow and analyze. Jordan and colleagues will present results of their study in San Diego Tuesday (Nov. 15) at the annual meeting of the American College of Rheumatology. Co-authors are UNC statistician Fang Fang; Dr. Lenore Arab of the University of California at Los Angeles; Dr. Steven J. Morris of the University of Missouri in Columbia; Dr. Jordan Renner, professor of radiology and allied health sciences at UNC; Dr. Charles G. Helmick of the Centers for Disease Control and Prevention (CDC) in Atlanta; and Dr. Marc C. Hochberg, professor of medicine at the University of Maryland. The team got interested in the possibility that selenium might play a role in preventing osteoarthritis in part because in severely selenium-deficient areas of China, people frequently develop Kashin-Beck disease, which cause joint problems relatively early in life. The U.S. study involved comparing the extent of knee osteoarthritis in each subject as shown on carefully examined X-rays with how much selenium was in their systems. At the University of Missouri, Morris determined the latter from toenail clippings taken during physical examinations in North Carolina. He employed a complicated nuclear technique known as Instrumental Neutron Activation Analysis. "We found that when we divided the participants into three groups, those with the highest selenium levels faced a 40 percent lower risk of knee osteoarthritis than those in the lowest-selenium group," Jordan said. "Those in the highest selenium group had only about half the chance of severe osteoarthritis or disease in both knees. Some of the findings were even stronger in African-Americans and women." The bottom line was that there appears to be a clear relationship between selenium and osteoarthritis, she said. "The next step will be in the laboratory to see how selenium affects cartilage," Jordan said. "It might act as a protective antioxidant. Later, we'll want to expand the study with larger samples and see whether selenium supplementation reduces pain or other symptoms." Most people get enough selenium in their diets in the United States if those diets are varied and include foods that come from different regions, she said. "If you were just growing most of your own food in soil that did not have much selenium and not eating vegetables and meat from elsewhere, you could potentially get in trouble with selenium deficiency," Jordan said. Osteoarthritis, the most common form of arthritis, afflicts almost a million North Carolinians and more than 21 million people nationally, including many adults over age 65, the physician said. Some estimates suggest that as many as 70 million Americans will suffer from some form of arthritis within the next 20 years as baby boomers age. ### Support for the research came from the CDC and the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Childhood immunizations are under greater levels of scrutiny by the public. Media stories publicizing the possible link of autism to vaccinations have resulted in parental refusal of immunizations for their young children. A recent study of pediatricians' attitudes toward patients who question the need for childhood immunizations found that many pediatricians would prefer to discharge patients who did not comply with their recommendations. Click on the URL below for the rest of this story:

Non-Narcotic Analgesic Dose and Risk of Incident Hypertension in US Women John P. Forman*; Meir J. Stampfer; and Gary C. Curhan Abstract Acetaminophen, ibuprofen, and aspirin are the most commonly used drugs in the United States. Although the frequency of their use has been associated with hypertension, prospective data examining the dose of these drugs and risk of hypertension are lacking. Furthermore, whether certain indications for analgesic use, particularly headache, mediate the association is unclear. We conducted 2 prospective cohort studies among older women 51 to 77 years of age (n=1903) from the Nurses’ Health Study I and younger women 34 to 53 years of age (n=3220) from the Nurses’ Health Study II who completed detailed supplemental questionnaires pertaining to their analgesic use and who did not have hypertension at baseline. We analyzed incident hypertension according to categories of average daily dose of acetaminophen, nonsteroidal anti-inflammatory drugs, and aspirin. Information on indications for analgesic use as well as relevant confounders was also gathered prospectively. Compared with women who did not use acetaminophen, the multivariable adjusted relative risk for those who took >500 mg per day was 1.93 (1.30 to 2.88) among older women and 1.99 (1.39 to 2.85) among younger women. For nonsteroidal anti-inflammatory drugs, similar comparisons yielded multivariable relative risks of 1.78 (1.21 to 2.61) among older women and 1.60 (1.10 to 2.32) among younger women. These associations remained significant among women who did not report headache. Aspirin dose was not significantly associated with hypertension. Higher daily doses of acetaminophen and nonsteroidal anti-inflammatory drugs independently increase the risk of hypertension in women. Because acetaminophen and nonsteroidal anti-inflammatory drugs are commonly used, they may contribute to the high prevalence of hypertension in the United States. From the Renal Division (J.P.F., G.C.C.), Department of Medicine, Brigham and Women’s Hospital, Boston, Mass; Channing Laboratory (J.P.F., M.J.S., G.C.C.), Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Mass; and Department of Epidemiology (J.P.F., M.J.S., G.C.C.), Harvard School of Public Health, Boston, Mass. Hypertension published August 15, 2005, 0.1161/01.HYP.0000177437.07240.70