ABSTRACT Background: Ad libitum, low-carbohydrate diets decrease caloric intake and cause weight loss. It is unclear whether these effects are due to the reduced carbohydrate content of such diets or to their associated increase in protein intake. Objective: We tested the hypothesis that increasing the protein content while maintaining the carbohydrate content of the diet lowers body weight by decreasing appetite and spontaneous caloric intake. Design: Appetite, caloric intake, body weight, and fat mass were measured in 19 subjects placed sequentially on the following diets: a weight-maintaining diet (15% protein, 35% fat, and 50% carbohydrate) for 2 wk, an isocaloric diet (30% protein, 20% fat, and 50% carbohydrate) for 2 wk, and an ad libitum diet (30% protein, 20% fat, and 50% carbohydrate) for 12 wk. Blood was sampled frequently at the end of each diet phase to measure the area under the plasma concentration versus time curve (AUC) for insulin, leptin, and ghrelin. Results: Satiety was markedly increased with the isocaloric high-protein diet despite an unchanged leptin AUC. Mean (±SE) spontaneous energy intake decreased by 441 ± 63 kcal/d, body weight decreased by 4.9 ± 0.5 kg, and fat mass decreased by 3.7 ± 0.4 kg with the ad libitum, high-protein diet, despite a significantly decreased leptin AUC and increased ghrelin AUC. Conclusions: An increase in dietary protein from 15% to 30% of energy at a constant carbohydrate intake produces a sustained decrease in ad libitum caloric intake that may be mediated by increased central nervous system leptin sensitivity and results in significant weight loss. This anorexic effect of protein may contribute to the weight loss produced by low-carbohydrate diets. American Journal of Clinical Nutrition, Vol. 82, No. 1, 41-48, July 2005 © 2005 American Society for Clinical Nutrition

Effect of Soybean Protein on Blood Pressure: A Randomized, Controlled Trial Jiang He, MD, PhD; Dongfeng Gu, MD, MS; Xigui Wu, MD; Jichun Chen, MSc; Xiufang Duan, MD; Jing Chen, MD, MSc; and Paul K. Whelton, MD, MSc ABSTRACT Background: Objective: Design: Setting: Patients: Intervention: Measurements: Results: Limitations: Conclusions:

ABSTRACT Objective. Each year, children die from heat stroke after being left unattended in motor vehicles. In 2003, the total was 42, up from a national average of 29 for the past 5 years. Previous studies found that on days when ambient temperatures exceeded 86°F, the internal temperatures of the vehicle quickly reached 134 to 154°F. We were interested to know whether similarly high temperatures occurred on clear sunny days with more moderate temperatures. The objective of this study was to evaluate the degree of temperature rise and rate of rise in similar and lower ambient temperatures. In addition, we evaluated the effect of having windows "cracked" open. Methods. . In this observational study, temperature rise was measured continuously over a 60-minute period in a dark sedan on 16 different clear sunny days with ambient temperatures ranging from 72 to 96°F. On 2 of these days, additional measurements were made with the windows opened 1.5 inches. Analysis of variance was used to compare how quickly the internal vehicle temperature rose and to compare temperature rise when windows were cracked open 1.5 inches. Results. . Regardless of the outside ambient temperature, the rate of temperature rise inside the vehicle was not significantly different. The average mean increase was 3.2°F per 5-minute interval, with 80% of the temperature rise occurring during the first 30 minutes. The final temperature of the vehicle depended on the starting ambient temperature, but even at the coolest ambient temperature, internal temperatures reached 117°F. On average, there was an 40°F increase in internal temperature for ambient temperatures spanning 72 to 96°F. Cracking windows open did not decrease the rate of temperature rise in the vehicle (closed: 3.4°F per 5 minutes; opened: 3.1°F per 5 minutes or the final maximum internal temperature. Conclusions. Even at relatively cool ambient temperatures, the temperature rise in vehicles is significant on clear, sunny days and puts infants at risk for hyperthermia. Vehicles heat up rapidly, with the majority of the temperature rise occurring within the first 15 to 30 minutes. Leaving the windows opened slightly does not significantly slow the heating process or decrease the maximum temperature attained. Increased public awareness and parental education of heat rise in motor vehicles may reduce the incidence of hyperthermia death and improve child passenger safety. To read the full report click on the link below. Full Text PEDIATRICS Vol. 116 No. 1 July 2005, pp. e109-e112

A new study funded by the Canadian Institute for Health Information’s Canadian Population Health Initiative shows that Old Order Mennonite children from Ontario living a similar lifestyle to that of previous generations tend to be fitter, stronger and leaner than children living a contemporary Canadian lifestyle—this despite the fact they do not have physical education classes and do not participate in organized sports. New analyses by obesity expert Dr. Mark S. Tremblay and a group of researchers from the University of Saskatchewan and University of Lethbridge found a strong link between contemporary lifestyles in Canadian children and reduced physical activity and fitness. “What this study proves is that you don’t need to do triathlons to stay fit and active,” says Dr. Tremblay, a Professor of Kinesiology at the University of Saskatchewan. “Children living traditional lifestyles have exercise embedded in their daily lives. In contrast, today’s children engage more in passive activities, such as video games. This may go a long way in explaining why they are less physically fit.” The study found that Old Order Mennonite children, on average, do up to 18 minutes more moderate or vigorous physical activity a day than urban and rural contemporary children. Researchers estimate that, all else being equal, this translates into a caloric difference between the Old Order Mennonite children and children living a contemporary lifestyle of approximately 15,000 kcal per year—or over 40 pounds of fat per person, per decade. The Old Order Mennonite children in the study also had leaner triceps than urban Saskatchewan children, a greater aerobic fitness score than rural Saskatchewan children, and greater grip strength than both rural and urban Saskatchewan children. These findings were true for girls and boys. Researchers attribute the Old Order Mennonite children’s strength and fitness to the fact they get a great deal of physical activity through walking, traditional farming activities and household chores. “Since obesity can lead to life-long health problems, including diabetes and heart disease, it may well be worthwhile to look at how aspects of modern lifestyles may contribute to childhood obesity,” says Lisa Sullivan, Manager of Research and Policy at the Canadian Population Health Initiative. “This research gives us a unique glimpse into the past that may help to explain the rising rates of obesity over the past few decades.” Approximately 30% of all the children in the study were classified as overweight—a figure that is consistent with nationally representative data. Methodology A cross-sectional study design was used to examine physical fitness and activity characteristics of three groups of children aged 8 to 13: Old Order Mennonite children from Ontario; Urban Saskatchewan children; and Rural Saskatchewan children. The data collection for this study took place from September to December 2002. Researchers assessed fitness by collecting height, weight, triceps skin fold, grip strength, push-ups, partial curl-ups and aerobic fitness measurements. Also, physical activity levels were measured for seven consecutive days using an accelerometer—an instrument that measures the intensity of body acceleration—and estimated from a self-reported physical activity questionnaire for older children. Canadian Population Health Initiative The Canadian Population Health Initiative (CPHI), which is part of the Canadian Institute for Health Information (CIHI), funded the research described in this media release. CPHI supports research to advance knowledge on the determinants of health in Canada and to develop policy options to improve population health and reduce health inequalities. Canadian Institute for Health Information (CIHI) The Canadian Institute for Health Information (CIHI) is an independent, pan-Canadian, not-for-profit organization working to improve the health of Canadians and the health care system by providing quality health information. CIHI’s mandate, as established by Canada’s health ministers, is to coordinate the development and maintenance of a common approach to health information for Canada. To this end, CIHI is responsible for providing accurate and timely information that is needed to establish sound health policies, manage the Canadian health system effectively and create public awareness of factors affecting good health. Media contacts: Leona Hollingsworth (613) 241-7860, Ext. 4140 Cell: (613) 612-3915

Today we celebrate the 229th birthday of the United States of America. On July 4, 1776, the Second Continental Congress unanimously adopted the Declaration of Independence, as we claimed our independence from Britain. On behalf of the NYSCA’s Officers, we want to wish you and your family a Happy 4th of July. To celebrate 4th of July with your own fire works show, click on the “Fire Works” below. Fire Works Also, examine the US Constitution by clicking on this link.

Abstract: Ambulatory Care Visits for Treating Adverse Drug Effects in the United States, 1995–2001: Zhan, Chunliu; Arispe, Irma; Kelley, Edward; Ding, Tina; Burt, Catharine W.; Shinogle, Judith; Stryer, Daniel Background:: Adverse drug events (ADEs) are a well-recognized patient safety concern, but their magnitude is unknown. Ambulatory visits for treating adverse drug effects (VADEs) as recorded in national surveys offer an alternative way to estimate the national prevalence of ADEs because each VADE indicates that an ADE occurred and was serious enough to require care. Methods: A nationally representative sample of visits to physician offices, hospital outpatient departments, and emergency departments was analyzed. VADEs were identified as the first-listed cause of injury. Results: In 2001, there were 4.3 million VADEs in the United States, averaging 15 visits per 1,000 population. VADE rates at physician offices, hospital outpatient departments, and hospital emergency departments were at 3.7, 3.4, and 7.3 per 1,000 visits, respectively. There was an upward trend in the total number of VADEs from 1995 to 2001 (p < .05), but the increases in VADEs per 1,000 visits and per 1,000 population were not statistically significant. VADEs were lower in children younger than 15 and higher in the elderly aged 65–74 than in adults aged 25–44 (p < .01) and were more frequent in females than in males (p < .05). Discussion: Although methodologically conservative, the study suggests that ADEs are a significant threat to patient safety in the United States. Joint Commission Journal on Quality and Patient Safety, July 2005, vol. 31, no. 7, pp. 372-378(7)

New study confirms conclusions from earlier studies linking sleep disorders and inattention in children. Children who snore may be at greater risk of becoming hyperactive later in life than those who sleep quietly. The study, published in the journal Sleep, corroborate earlier conclusions linking sleep disorders and hyperactivity, with snoring coming first followed by hyperactivity. ABSTRACT Autonomic Dysfunction in Children with Sleep-Disordered Breathing Louise M. O’Brien, PhD; David Gozal, MD - Kosair Children’s Hospital Research Institute, and Division of Pediatric Sleep Medicine, Department of Pediatrics, University of Louisville, Louisville, KY Study Objectives: To measure sympathetic responses in children with and without sleep-disordered breathing. Design: Prospective, observational study. Setting: Kosair Children’s Hospital Sleep Medicine and Apnea Center. Participants: Subjects were prospectively recruited from children undergoing overnight polysomnographic assessments and were retrospectively grouped according to the results of the polysomnogram. Sleep-disordered breathing was defined as an apnea-hypopnea index >5 and children were assigned to the control group if their apnea-hypopnea index was < 1. Intervention: N/A. Measurements and Results: During quiet wakefulness, pulse arterial tonometry was used to assess changes in sympathetic activity following vital capacity sighs in 28 children with sleep-disordered breathing and 29 controls. Each child underwent a series of 3 sighs, and the average maximal pulse arterial tonometry signal attenuation was calculated. Further, a cold pressor test was conducted in a subset of 14 children with sleep-disordered breathing and 14 controls. The left hand was immersed in ice cold water for 30 seconds while right-hand pulse arterial tonometry signal was continuously monitored during immersion and 20-minute recovery periods. Signal amplitude changes were expressed as percentage change from corresponding baseline. Results: The magnitude of sympathetic discharge-induced attenuation of pulse arterial tonometry signal was significantly increased in children with sleep-disordered breathing during sigh maneuvers (74.1%±10.7% change compared with 59.2%±13.2% change in controls; P<.0001) and the cold pressor test (83.5%±7.3% change compared with 74.1%±11.4% change in controls; P=.039). Further, recovery kinetics in control children were faster than those of children with sleep-disordered breathing. Conclusion: Children with sleep-disordered breathing have altered autonomic nervous system regulation as evidenced by increased sympathetic vascular reactivity during wakefulness. Journal SLEEP Volume 28/ Issue 6, June 1, 2005, Pages 747-752

Information Leaflet and Antibiotic Prescribing Strategies for Acute Lower Respiratory Tract Infection Paul Little, MD; Kate Rumsby, BA; Joanne Kelly, BSc; Louise Watson, PhD; Michael Moore, MRCGP; Gregory Warner, MRCGP; Tom Fahey, MD; Ian Williamson, MD ABSTRACT Context Acute lower respiratory tract infection is the most common condition treated in primary care. Many physicians still prescribe antibiotics; however, systematic reviews of the use of antibiotics are small and have diverse conclusions. Objective To estimate the effectiveness of 3 prescribing strategies and an information leaflet for acute lower respiratory tract infection. Design, Setting, and Patients A randomized controlled trial conducted from August 18, 1998, to July 30, 2003, of 807 patients presenting in a primary care setting with acute uncomplicated lower respiratory tract infection. Patients were assigned to 1 of 6 groups by a factorial design: leaflet or no leaflet and 1 of 3 antibiotic groups (immediate antibiotics, no offer of antibiotics, and delayed antibiotics). Intervention Three strategies, immediate antibiotics (n = 262), a delayed antibiotic prescription (n = 272), and no offer of antibiotics (n = 273), were prescribed. Approximately half of each group received an information leaflet (129 for immediate antibiotics, 136 for delayed antibiotic prescription, and 140 for no antibiotics). Main Outcome Measures Symptom duration and severity. Results A total of 562 patients (70%) returned complete diaries and 78 (10%) provided information about both symptom duration and severity. Cough rated at least "a slight problem" lasted a mean of 11.7 days (25% of patients had a cough lasting 17 days). An information leaflet had no effect on the main outcomes. Compared with no offer of antibiotics, other strategies did not alter cough duration (delayed, 0.75 days; 95% confidence intervals [CI], –0.37 to 1.88; immediate, 0.11 days; 95% CI, –1.01 to 1.24) or other primary outcomes. Compared with the immediate antibiotic group, slightly fewer patients in the delayed and control groups used antibiotics (96%, 20%, and 16%, respectively; P<.001), fewer patients were "very satisfied" (86%, 77%, and 72%, respectively; P = .005), and fewer patients believed in the effectiveness of antibiotics (75%, 40%, and 47%, respectively; P<.001). There were lower reattendances within a month with antibiotics (mean attendances for no antibiotics, 0.19; delayed, 0.12; and immediate, 0.11; P = .04) and higher attendance with a leaflet (mean attendances for no leaflet, 0.11; and leaflet, 0.17; P = .02). Conclusion No offer or a delayed offer of antibiotics for acute uncomplicated lower respiratory tract infection is acceptable, associated with little difference in symptom resolution, and is likely to considerably reduce antibiotic use and beliefs in the effectiveness of antibiotics. Author Affiliations: Primary Medical Care Group, University of Southampton, Highfield (Drs Little, Watson, and Williamson, and Mss Rumsby and Kelly); Nightingale Surgery, Romsey, Hants (Dr Warner); Three Swans Surgery, Salisbury (Drs Moore and Fahey), England; and Department of Primary Care, Dundee University, Dundee, Scotland (Dr Fahey). JAMA. 2005;293:3029-3035

ABSTRACT Background Premenstrual syndrome (PMS) is one of the most common disorders of premenopausal women. Studies suggest that blood calcium and vitamin D levels are lower in women with PMS and that calcium supplementation may reduce symptom severity, but it is unknown whether these nutrients may prevent the initial development of PMS. Methods We conducted a case-control study nested within the prospective Nurses’ Health Study II cohort. Participants were a subset of women aged 27 to 44 years and free from PMS at baseline in 1991, including 1057 women who developed PMS over 10 years of follow-up and 1968 women reporting no diagnosis of PMS and no or minimal menstrual symptoms. Intake of calcium and vitamin D was measured in 1991, 1995, and 1999 by a food frequency questionnaire. Results After adjustment for age, parity, smoking status, and other risk factors, women in the highest quintile of total vitamin D intake (median, 706 IU/d) had a relative risk of 0.59 (95% confidence interval, 0.40-0.86) compared with those in the lowest quintile (median, 112 IU/d) (P = .01 for trend). The intake of calcium from food sources was also inversely related to PMS; compared with women with a low intake (median, 529 mg/d), participants with the highest intake (median, 1283 mg/d) had a relative risk of 0.70 (95% confidence interval, 0.50-0.97) (P = .02 for trend). The intake of skim or low-fat milk was also associated with a lower risk (P<.001). Conclusions A high intake of calcium and vitamin D may reduce the risk of PMS. Large-scale clinical trials addressing this issue are warranted. Given that calcium and vitamin D may also reduce the risk of osteoporosis and some cancers, clinicians may consider recommending these nutrients even for younger women. Author Affiliations: Department of Public Health, University of Massachusetts, Amherst (Dr Bertone-Johnson); Channing Laboratory (Drs Hankinson, Willett, and Manson) and Division of Preventive Medicine (Dr Manson), Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Mass; Departments of Epidemiology (Drs Hankinson, Willett, and Manson) and Nutrition (Dr Willett), Harvard School of Public Health, Boston; GlaxoSmithKline Consumer Healthcare, Parsippany, NJ (Dr Bendich); and Department of Obstetrics and Gynecology, The University of Iowa, Iowa City (Dr Johnson). Arch Intern Med. 2005;165:1246-1252.

IMMEDIATE ACTION REQUIRED Earlier this week, Senate Bill S.3169a and Assembly Bill A.5622a, legislation that would grant physical therapists “direct access” in New York state were amended to “A” prints and started to move. The former Senate Bill, S.3169, contained protections penned into the legislation by the NYSCA and the Medical Society in the Fall of 2002. These protections have been completely discarded in the “A” print of S.3169 – now S.3169a. The companion legislation in the state Assembly, A. 5622a, has been amended to mirror the Senate legislation making the possibility of passage of Physical Therapy Direct Access more probable. YOU NEED TO ACT NOW. For more information, click on the link below.

One of the most common disorders of premenopausal women is premenstrual syndrome (PMS) however, women that get plenty of calcium and vitamin D may prevent PMS. ABSTRACT Background Premenstrual syndrome (PMS) is one of the most common disorders of premenopausal women. Studies suggest that blood calcium and vitamin D levels are lower in women with PMS and that calcium supplementation may reduce symptom severity, but it is unknown whether these nutrients may prevent the initial development of PMS. Methods We conducted a case-control study nested within the prospective Nurses’ Health Study II cohort. Participants were a subset of women aged 27 to 44 years and free from PMS at baseline in 1991, including 1057 women who developed PMS over 10 years of follow-up and 1968 women reporting no diagnosis of PMS and no or minimal menstrual symptoms. Intake of calcium and vitamin D was measured in 1991, 1995, and 1999 by a food frequency questionnaire. Results After adjustment for age, parity, smoking status, and other risk factors, women in the highest quintile of total vitamin D intake (median, 706 IU/d) had a relative risk of 0.59 (95% confidence interval, 0.40-0.86) compared with those in the lowest quintile (median, 112 IU/d) (P = .01 for trend). The intake of calcium from food sources was also inversely related to PMS; compared with women with a low intake (median, 529 mg/d), participants with the highest intake (median, 1283 mg/d) had a relative risk of 0.70 (95% confidence interval, 0.50-0.97) (P = .02 for trend). The intake of skim or low-fat milk was also associated with a lower risk (P<.001). Conclusions A high intake of calcium and vitamin D may reduce the risk of PMS. Large-scale clinical trials addressing this issue are warranted. Given that calcium and vitamin D may also reduce the risk of osteoporosis and some cancers, clinicians may consider recommending these nutrients even for younger women. Archives of Internal Medicine 2005;165:1246-1252.

According to a research published in the June 11, 2005 issue of The British Medical Journal, painkillers with ibuprofen may increase the risk of heart attacks by up to 24 percent. Abstract Aims To determine the comparative risk of myocardial infarction in patients taking cyclo-oxygenase-2 and other non-steroidal anti-inflammatory drugs (NSAIDs) in primary care between 2000 and 2004; to determine these risks in patients with and without pre-existing coronary heart disease and in those taking and not taking aspirin. Design Nested case-control study. Setting 367 general practices contributing to the UK QRESEARCH database and spread throughout every strategic health authority and health board in England, Wales, and Scotland. Subjects 9218 cases with a first ever diagnosis of myocardial infarction during the four year study period; 86 349 controls matched for age, calendar year, sex, and practice. Outcome measures Unadjusted and adjusted odds ratios with 95% confidence intervals for myocardial infarction associated with rofecoxib, celecoxib, naproxen, ibuprofen, diclofenac, and other selective and non-selective NSAIDS. Odds ratios were adjusted for smoking status, comorbidity, deprivation, and use of statins, aspirin, and antidepressants. Results A significantly increased risk of myocardial infarction was associated with current use of rofecoxib (adjusted odds ratio 1.32, 95% confidence interval 1.09 to 1.61) compared with no use within the previous three years; with current use of diclofenac (1.55, 1.39 to 1.72); and with current use of ibuprofen (1.24, 1.11 to 1.39). Increased risks were associated with the other selective NSAIDs, with naproxen, and with non-selective NSAIDs; these risks were significant at < 0.05 rather than < 0.01 for current use but significant at < 0.01 in the tests for trend. No significant interactions occurred between any of the NSAIDs and either aspirin or coronary heart disease. Conclusion These results suggest an increased risk of myocardial infarction associated with current use of rofecoxib, diclofenac, and ibuprofen despite adjustment for many potential confounders. No evidence was found to support a reduction in risk of myocardial infarction associated with current use of naproxen. This is an observational study and may be subject to residual confounding that cannot be fully corrected for. However, enough concerns may exist to warrant a reconsideration of the cardiovascular safety of all NSAIDs. BMJ 2005;330:1366 (11 June)

The New York State Department of Health (DOH) today released changes in New York's health advisories in the 2005-06 'Chemicals in Sportfish and Game.' This year's guide highlights health advisory changes for 25 ponds, lakes and reservoirs across the state. Twenty-four of the 25 advisories were issued due to mercury contamination identified in fish. As a result of these findings, the DOH is advising women of childbearing years and children under the age of 15 to avoid eating ANY FISH from the waters listed below. They should also avoid eating specific species of fish (northern pike, pickerel, walleye, largemouth bass, smallmouth bass and larger yellow perch) from ALL WATERS in the Adirondack and Catskill Mountain regions because of mercury contamination. The DOH recommends that all other individuals adhere to the advisories and the specified limits listed below when eating fish. The New York State Department of Environmental Conservation (DEC) regularly samples fish in New York State waters. The new information on mercury in fish is part of a comprehensive DEC study supported by the New York State Energy Research and Development Authority. Mercury and other contaminants may affect the nervous system and organs in the fetus, newborns and young children. Some of these contaminants may also build up in women's bodies and some chemicals may be passed to newborns in their mother's milk. Because some contaminants may accumulate and remain in the body for a long time, women should follow the stricter consumption advice throughout their childbearing years. New York State's waters include more than 70,000 miles of rivers and streams, three million acres in thousands of lakes, reservoirs and ponds and one million acres of marine waters. New York's fish monitoring and advisory program is among the most comprehensive in the nation. The DOH's annual health advisories provide advice for sports anglers, hunters and the general public about how to reduce exposure to chemical contaminants in the State's sportfish and game. Specific advisories now apply to 117 New York waters. This year, the DOH reviewed DEC sampling data collected from more than 2,500 fish in 84 waters across the state. A general, and long-standing, statewide advisory applies to sportfish taken from any fresh waters in the state and some marine waters at the mouth of the Hudson River. The general advice is to EAT NO MORE THAN ONE MEAL (1/2 pound) of fish per week. The fish advisories are published in the Fishing Regulations Guide and the game advisories are published in the Hunting and Trapping Regulations Guide issued by DEC. The complete Health Advisories and additional information can be obtained from the DOH's web site at http://www.nyhealth.gov/nysdoh/fish/fish.htm or by contacting the Department's toll-free information line at 1-800-458-1158. New DOH health advisories have been issued for the following waters: • Breakneck Pond (Rockland County) - EAT NO MORE THAN ONE MEAL PER MONTH of largemouth bass larger than 15 inches. • Canada Lake (Fulton County) - EAT NO MORE THAN ONE MEAL PER MONTH of smallmouth bass larger than 15 inches and chain pickerel (all sizes). • Chase Lake (Fulton County) - EAT NO MORE THAN ONE MEAL PER MONTH of yellow perch larger than 9 inches. • Chodikee Lake (Ulster County) - EAT NO MORE THAN ONE MEAL PER MONTH of largemouth bass larger than 15 inches. • Crane Pond (Essex County) - EAT NO MORE THAN ONE MEAL PER MONTH of smallmouth bass larger than 15 inches. • Dunham Reservoir (Rensselaer County) – EAT NO walleye and EAT NO MORE THAN ONE MEAL PER MONTH of smallmouth bass (all sizes). • Elmer Falls Reservoir (Lewis County) - EAT NO MORE THAN ONE MEAL PER MONTH of smallmouth bass (all sizes). • Francis Lake (Lewis County) –EAT NO MORE THAN ONE MEAL PER MONTH of chain pickerel (all sizes). In addition, based on lower mercury levels in smaller yellow perch, the previous advisory for yellow perch has been changed to EAT NO MORE THAN ONE MEAL PER MONTH of yellow perch larger than 9 inches (the previous advisory applied for all sizes of yellow perch.) • Franklin Falls Flow (also known as Franklin Falls Pond; Franklin and Essex Counties) - EAT NO walleye (all sizes). • High Falls Pond (Lewis County) - EAT NO MORE THAN ONE MEAL PER MONTH of smallmouth bass larger than 15 inches. • Kings Flow (Hamilton County) - EAT NO MORE THAN ONE MEAL PER MONTH of smallmouth bass larger than 15 inches. • Loch Sheldrake (Sullivan County) - EAT NO MORE THAN ONE MEAL PER MONTH of walleye (all sizes). • Meacham Lake (Franklin County) - EAT NO smallmouth bass and EAT NO MORE THAN ONE MEAL PER MONTH of northern pike (all sizes of both species). • Middle Stoner Lake (Also known as East Stoner Lake; Fulton County) - EAT NO MORE THAN ONE MEAL PER MONTH of smallmouth bass larger than 15 inches. • Moshier Reservoir (Herkimer County) - EAT NO MORE THAN ONE MEAL PER MONTH of smallmouth bass (all sizes). • North-South Lake (Greene County) - EAT NO MORE THAN ONE MEAL PER MONTH of largemouth bass larger than 15 inches. • Red Lake (Jefferson County) - EAT NO MORE THAN ONE MEAL PER MONTH of walleye (all sizes). • Rio Reservoir (Orange and Sullivan Counties) - EAT NO MORE THAN ONE MEAL PER MONTH of smallmouth bass larger than 15 inches. • Russian Lake (Hamilton County) - EAT NO MORE THAN ONE MEAL PER MONTH of yellow perch larger than 9 inches. • Salmon River Reservoir (Oswego County) - EAT NO MORE THAN ONE MEAL PER MONTH of largemouth bass and smallmouth bass (all sizes of both species). • Spy Lake (Hamilton County) - EAT NO MORE THAN ONE MEAL PER MONTH of smallmouth bass larger than 15 inches. • Sunday Lake (Herkimer County) - EAT NO chain pickerel (all sizes). • Swinging Bridge Reservoir (Sullivan County) - EAT NO MORE THAN ONE MEAL PER MONTH of walleye (all sizes). • Weller Pond (Franklin County) - EAT NO MORE THAN ONE MEAL PER MONTH of northern pike (all sizes). • Advisory Change for Canadice Lake Canadice Lake (Ontario County) – The advisory for Canadice Lake trout has been changed to EAT NO MORE THAN ONE MEAL PER MONTH of lake trout larger than 25 inches, based on lower PCB levels in smaller lake trout (the previous advisory applied to all sizes of lake trout.) A previous advisory to EAT NO MORE THAN ONE MEAL PER MONTH of brown trout (all sizes) remains in effect.

ABSTRACT Background There is substantial evidence that antidepressant medications treat moderate to severe depression effectively, but there is less data on cognitive therapy’s effects in this population. Objective To compare the efficacy in moderate to severe depression of antidepressant medications with cognitive therapy in a placebo-controlled trial. Design Random assignment to one of the following: 16 weeks of medications (n = 120), 16 weeks of cognitive therapy (n = 60), or 8 weeks of pill placebo (n = 60). Setting Research clinics at the University of Pennsylvania, Philadelphia, and Vanderbilt University, Nashville, Tenn. Patients Two hundred forty outpatients, aged 18 to 70 years, with moderate to severe major depressive disorder. Interventions Some study subjects received paroxetine, up to 50 mg daily, augmented by lithium carbonate or desipramine hydrochloride if necessary; others received individual cognitive therapy. Main Outcome Measure The Hamilton Depression Rating Scale provided continuous severity scores and allowed for designations of response and remission. Results At 8 weeks, response rates in medications (50%) and cognitive therapy (43%) groups were both superior to the placebo (25%) group. Analyses based on continuous scores at 8 weeks indicated an advantage for each of the active treatments over placebo, each with a medium effect size. The advantage was significant for medication relative to placebo, and at the level of a nonsignificant trend for cognitive therapy relative to placebo. At 16 weeks, response rates were 58% in each of the active conditions; remission rates were 46% for medication, 40% for cognitive therapy. Follow-up tests of a site x treatment interaction indicated a significant difference only at Vanderbilt University, where medications were superior to cognitive therapy. Site differences in patient characteristics and in the relative experience levels of the cognitive therapists each appear to have contributed to this interaction. Conclusion Cognitive therapy can be as effective as medications for the initial treatment of moderate to severe major depression, but this degree of effectiveness may depend on a high level of therapist experience or expertise. Arch Gen Psychiatry. 2005;62:409-416. Author Affiliations: Departments of Psychology (Dr DeRubeis), and Psychiatry (Drs Amsterdam, Young, O’Reardon, and Gladis), University of Pennsylvania, Philadelphia; Departments of Psychology (Dr Hollon), and Psychiatry (Drs Shelton, Salomon, Lovett, and Brown), Vanderbilt University, Nashville, Tenn; Department of Mathematics and Applied Statistics, West Chester University, West Chester, Pa (Dr Gallop).

Each year, an estimated 200,000 to 600,000 Americans will suffer from deep-vein thrombosis (DVT) and pulmonary embolism (PE). DVT occurs usually in the lower limbs, when a blood clot forms in a deep vein. Pulmonary embolism a complication of DVT can occur when a clot breaks loose from the wall of the vein and travels to the lungs, blocking a pulmonary artery or one of its branches. PE will be fatal in 60,000 to 200,000 individuals who develop this condition. According to a national survey conducted on behalf of the American Public Health, almost three-quarters (74 percent) of adults have little or no awareness of DVT. Click here to assess your risk for DVT LEARN MORE ABOUT DEEP-VEIN THROMBOSIS AND PULMONARY EMBOLISM For additional information click on the link below.

ABSTRACT Background: Obesity is a strong risk factor for type 2 diabetes. However, few studies have compared the predictive power of overall obesity with that of central obesity. The cutoffs for waist circumference (WC) and waist-to-hip ratio (WHR) as measures of abdominal adiposity remain controversial. Objective: The objective was to compare body mass index (BMI), WC, and WHR in predicting type 2 diabetes. Design: A prospective cohort study (Health Professionals Follow-Up Study) of 27 270 men was conducted. WC, WHR, and BMI were assessed at baseline. Covariates and potential confounders were assessed repeatedly during the follow-up. Results: During 13 y of follow-up, we documented 884 incident type 2 diabetes cases. Age-adjusted relative risks (RRs) across quintiles of WC were 1.0, 2.0, 2.7, 5.0, and 12.0; those of WHR were 1.0, 2.1, 2.7, 3.6, and 6.9; and those of BMI were 1.0, 1.1, 1.8, 2.9, and 7.9 (P for trend < 0.0001 for all). Multivariate adjustment for diabetes risk factors only slightly attenuated these RRs. Adjustment for BMI substantially attenuated RRs for both WC and WHR. The receiver operator characteristic curve analysis indicated that WC and BMI were similar and were better than WHR in predicting type 2 diabetes. The cumulative proportions of type 2 diabetes cases identified according to medians of BMI (24.8), WC (94 cm), and WHR (0.94) were 82.5%, 83.6%, and 74.1%, respectively. The corresponding proportions were 78.9%, 50.5%, and 65.7% according to the recommended cutoffs. Conclusions: Both overall and abdominal adiposity strongly and independently predict risk of type 2 diabetes. WC is a better predictor than is WHR. The currently recommended cutoff for WC of 102 cm for men may need to be reevaluated; a lower cutoff may be more appropriate. American Journal of Clinical Nutrition, Vol. 81, No. 3, 555-563, March 2005 © 2005 American Society for Clinical Nutrition

ABSTRACT Background Little is known regarding the health effects of a raw food (RF) vegetarian diet. Methods We performed a cross-sectional study on 18 volunteers (mean ± SD age, 54.2 ± 11.5 years; male/female ratio, 11:7) on a RF vegetarian diet for a mean of 3.6 years and a comparison age- and sex-matched group eating typical American diets. We measured body composition, bone mineral content and density, bone turnover markers (C-telopeptide of type I collagen and bone-specific alkaline phosphatase), C-reactive protein, 25-hydroxyvitamin D, insulin-like growth factor 1, and leptin in serum. Results The RF vegetarians had a mean ± SD body mass index (calculated as weight in kilograms divided by the square of height in meters) of 20.5 ± 2.3, compared with 25.4 ± 3.3 in the control subjects. The mean bone mineral content and density of the lumbar spine (P= .003 and P<.001, respectively) and hip (P = .01 and P<.001, respectively) were lower in the RF group than in the control group. Serum C-telopeptide of type I collagen and bone-specific alkaline phosphatase levels were similar between the groups, while the mean 25-hydroxyvitamin D concentration was higher in the RF group than in the control group (P<.001). The mean serum C-reactive protein (P = .03), insulinlike growth factor 1 (P = .002), and leptin (P = .005) were lower in the RF group. Conclusion A RF vegetarian diet is associated with low bone mass at clinically important skeletal regions but is without evidence of increased bone turnover or impaired vitamin D status. Arch Intern Med. 2005;165:684-689. Author Affiliations: Section of Applied Physiology, Division of Geriatrics and Nutritional Science, Department of Internal Medicine, Washington University School of Medicine, St Louis, Mo (Drs Fontana, Holloszy, and Villareal and Ms Shew); and the Division of Food Science, Human Nutrition, and Health, Istituto Superiore di Sanitá, Rome, Italy (Dr Fontana).

ABSTRACT Background The risk of sudden death from cardiac causes in the general population peaks from 6 a.m. to noon and has a nadir from midnight to 6 a.m. Obstructive sleep apnea is highly prevalent and associated with neurohormonal and electrophysiological abnormalities that may increase the risk of sudden death from cardiac causes, especially during sleep. Methods We reviewed polysomnograms and the death certificates of 112 Minnesota residents who had undergone polysomnography and had died suddenly from cardiac causes between July 1987 and July 2003. For four intervals of the day, we compared the rates of sudden death from cardiac causes among people with obstructive sleep apnea and the following: the rates among people without obstructive sleep apnea, the rates in the general population, and the expectations according to chance. For each interval, we assessed the median apnea–hypopnea index and the relative risk of sudden death from cardiac causes. We similarly analyzed sudden death from cardiac causes during three time intervals that correlate with usual sleep–wake cycles. Results From midnight to 6 a.m., sudden death from cardiac causes occurred in 46 percent of people with obstructive sleep apnea, as compared with 21 percent of people without obstructive sleep apnea (P=0.01), 16 percent of the general population (P<0.001), and the 25 percent expected by chance (P<0.001). People with sudden death from cardiac causes from midnight to 6 a.m. had a significantly higher apnea–hypopnea index than those with sudden death from cardiac causes during other intervals, and the apnea–hypopnea index correlated directly with the relative risk of sudden death from cardiac causes from midnight to 6 a.m. For people with obstructive sleep apnea, the relative risk of sudden death from cardiac causes from midnight to 6 a.m. was 2.57 (95 percent confidence interval, 1.87 to 3.52). The analysis of usual sleep–wake cycles showed similar results. Conclusions People with obstructive sleep apnea have a peak in sudden death from cardiac causes during the sleeping hours, which contrasts strikingly with the nadir of sudden death from cardiac causes during this period in people without obstructive sleep apnea and in the general population. The New England Journal of Medicine Volume 352:1206-1214

ABSTRACT Objective: The objective of this study was to review the evidence that behavioral and emotional factors are triggers of acute coronary syndromes. Method: Systematic review of the published literature from 1970 to 2004 of trigger events, defined as stimuli or activities occurring within 24 hours of the onset of acute coronary syndromes. Results: There is consistent evidence that physical exertion (particularly by people who are not normally active), emotional stress, anger, and extreme excitement can trigger acute myocardial infarction and sudden cardiac death in susceptible individuals. Many triggers operate within 1 to 2 hours of symptom onset. There are methodologic limitations to the current literature, including sampling, retrospective reporting, and presentation biases, the role of memory decay and salience, and reverse causation because of silent prodromal events. Conclusions: Behavioral and emotional factors are probable triggers of acute coronary syndromes in vulnerable individuals, and the pathophysiological processes elicited by these stimuli are being increasingly understood. The benefits to patients of knowledge to these processes have yet to accrue. Psychosomatic Medicine 67:179-186 (2005) © 2005